2018 Ottawa consensus statement: Selection and recruitment to the healthcare professions.

Selection and recruitment into healthcare education and practice is a key area of interest for educators with significant developments in research, policy, and practice in recent years. This updated consensus statement, developed through a multi-stage process, examines future opportunities and challenges in selection and recruitment. There is both a gap in the literature around and a compelling case for further theoretical and empirical literature to underpin the development of overall selection philosophes and policies and their enactment. More consistent evidence has emerged regarding the quality of different selection methods. Approaches to selection are context-dependent, requiring the consideration of an institution's philosophy regarding what they are trying to achieve, the communities it purports to serve, along with the system within which they are used. Diversity and globalization issues continue to be critically important topics. Further research is required to explore differential attainment and explain why there are substantial differences in culturally acceptable ways of approaching diversity and widening access. More sophisticated evaluation approaches using multi-disciplinary theoretical frameworks are required to address the issues. Following a discussion of these areas, 10 recommendations are presented to guide future research and practice and to encourage debate between colleagues across the globe.

Comparison of weighted and composite scores for pre-clinical dental learners.

PURPOSE: The weighted mean (WM) method for combining scores of assessment components can provide outcomes with biased reliability and score precision. The objective of this study was to compare the traditional WM with another method utilising the composite score (CS) principle for combining scores of a final summative assessment exercise for a pre-clinical dental course. METHODS: Data were collected from the final examination of third-year Preclinical Operative and Esthetic Dentistry course consisting of 3 parts: practical competency, objective structured practical examination and a written examination with weights of 33%, 17% and 50%, respectively. Scores from the 3 components were combined using the WM and CS methods. Weighted kappa was used to compare both approaches for agreement, and students' ranks were also compared. RESULTS: Combining scores using CS scheme produced lower scores overall compared to WM with more apparent effect for the male group. Agreement between WM and CS was moderate (κ = 0.44) with major differences between students' ranks across the 2 modalities as only 21% of the cohort retained their ranks. CONCLUSION: The CS method produced more reliable scores, resulting in moderate agreement with the WM and major shift in students' ranks. These findings necessitate further validity considerations before implementing the CS method and call for further studies that examine the consequences of composite measures in dental education.

Challenging the arbitrary cutoff score of 60%: Standard setting evidence from preclinical Operative Dentistry course.

INTRODUCTION: This paper conducted standard setting (SS) (Angoff and Hofstee methods) to determine cutoff scores for summative examinations and to compare the derived passing levels to the existing fixed passing score of 60% in the Faculty of Dentistry at King Abdulaziz University. METHODS: Historic performance data for final examinations in preclinical Operative Dentistry course were used by four raters to conduct both Angoff and Hofstee methods to determine the cut off scores for three academic years (2012, 2013, and 2014). RESULTS: Both methods yielded higher than 60% cut off scores for each year. For the first examination of academic year 2012, the cutoff score was 64.75, while it was 63.5 for year 2013, and 66.75 for the last academic year of 2014. Hofstee scores were 64.5, 65.25, and 62.25 consecutively for years 2012 through 2014. CONCLUSIONS: Using Angoff or Hofstee methods, yielded higher than the fixed 60% passing score currently used by the dental school. The use of Angoff method alone is encouraged as there were limitations to using the Hofstee method to determine the cut off score. This finding provides preliminary support to use evidence-based SS methods to determine the cutoff score for the whole Dentistry program.

Restructuring an undergraduate dental curriculum to global standards--a case study in an Indian dental school.

Globalisation has affected all aspects of life and dentistry is no exception. In the context of today's dentist being a global citizen, undergraduate training in dentistry is set to ensure converging standards so that international recognition of dental qualifications can move forward. The decision of the Dental Council of India to expand the undergraduate dental program to five years provides an opportunity to be part of the endeavor of the Global Dental Congress to achieve converging standards which was initially for the European Union, and now spreading out globally. Economic emergence in Indian subcontinent has resulted in growing oral health care needs both in quality and quantity. To address this issue, the graduating dentist needs to be trained following a competency based curricular model. Access to Internet facilitated the goal of achieving converging standards of dental schools to be feasible because of the instant communication and capacity to share information about training strategies via technology across the globe. Upgrading the undergraduate training to global standards by dental schools in India could be a wise and strategic move both for attracting students to study in India, as well as retaining the graduates after their training. The following is a case study of an Indian dental school set to restructure the undergraduate curriculum to global standards using the 8 steps of Kotter's transformational change. Change in curriculum and the subsequent accreditation of the school in global platform not only attracts prospective students but also results in producing competent dentists. Dental education provided by the institution can result in quality assurance, benchmarking the assessment system to achieve international recognition. This paper highlights the need and importance of facilitation of international convergence with long term aspirations for mutual recognition of international degrees.

The myopathology of Behçet's disease--a histochemical, light-, and electron-microscopic study.

The myopathology of Behçet's disease is described in 7 patients using conventional light microscopy, histochemistry, high-resolution light microscopy and electron microscopy. Two patients had clinical evidence of peripheral neuropathy: 5 patients had no clinical evidence of neuromuscular involvement. Histochemical profile of muscle in all patients was normal. Abnormalities in muscle histology using conventional light microscopy were found in only 1 patient. High-resolution light microscopy revealed abnormalities in 3 patients whereas electron microscopy revealed abnormalities in muscle of all 7 patients. The myopathology of Behçet's disease includes thickening of capillary basement membrane, excessive pleating of sarcolemma, subsarcolemmal aggregates of mitochondria and glycogen, disorganization and breakdown of myofibrils, central nucleation and the presence of a variety of cytoplasmic inclusions. No virus particles were present.

Minority students, affirmative action, and the admission process: a survey of 15 medical schools.

PURPOSE: To assess the current state of admission policies for underrepresented minorities (URMs) at medical schools. METHOD: In 1997, the author surveyed the admission directors at the 15 medical schools with the largest URM populations. The four categories in the questionnaire covered the makeup of the admission committee, the weights given quantitative factors in admission decisions, the weights given qualitative factors, and the weight given the applicant's status as a URM or disadvantaged student. RESULTS: The 12 responding admission directors provided a wide range of answers as to the makeup of the admission committee and the weights assigned quantitative and qualitative factors. None of the schools gave an exact percentage weight to URM status, although one school added points to a diversity index, which was then used as a quantitative measure. There appears to be an increasing focus on economic and educational disadvantage. CONCLUSIONS: The limited parameters of the study prevent the author from offering definitive solutions. However, the responses to the survey suggest that admission policies are secretive and widely varied. The academic community must consider the reasons behind and the consequences of abandoning a forthright approach to affirmative action.

Attrition rates of underrepresented minority students at the University of Illinois at Chicago College of Medicine, 1993-1997.

PURPOSE: To examine the attrition rates of underrepresented minority (URM) students and non-URM students at the University of Illinois at Chicago's College of Medicine (UIC-COM). METHOD: The study used 11 categories of information about URM and non-URM students at UIC-COM for the five academic years 1993-1997 to determine how many students withdrew and why. RESULTS: Of 895 graduates during these five years, 166 (18.5%) were URM students. The attrition rates were 6.5% for all graduates, 16.2% for URM students, and 4.0% for non-URM students. Students who withdrew because of academic difficulties comprised 75% of URM withdrawals and 57% of non-URM withdrawals. CONCLUSION: Many URM students need special academic attention after matriculation. Existing academic support programs should be assessed regularly to ascertain whether they may be improved to minimize attrition.

The impact of mentoring and advising at-risk underrepresented minority students on medical school performance.

This pilot study examined the impact of mentoring and advising at-risk underrepresented minority students received prior to matriculation on their performance in medical school.

Is a mandatory general surgery rotation necessary in the surgical clerkship?

BACKGROUND: Changes in the spectrum of general surgery and the delivery of surgical care have placed the requirement for a mandatory general surgery rotation in the surgical clerkship in question. METHODS: We tested the hypothesis that equal mastery of surgical clerkship objectives can be obtained in a clerkship with and without general surgery. Students chose any two surgical rotations and were assessed by written examination, objective structured clinical examination (OSCE), ward evaluations, self-assessment objectives questionnaire, and satisfaction survey. RESULTS: Data for 54 students showed no differences in scores between groups on any parameter. No specific concerns related to the absence of general surgery were identified. CONCLUSIONS: Effective undergraduate surgical education can be offered in many specialty settings. Removal of the requirement for general surgery in clerkship may lead to a more effective use of all educational opportunities. A careful analysis of local programs and facilities is necessary before suggesting this change to other institutions.

Minority students, affirmative action, and the admission process: a literature review, 1987-1998.

BACKGROUND: Despite numerous initiatives, medical educators have failed to effect a sustainable increase in the number of underrepresented minority students at medical colleges in the United States. This study reviewed the recent literature regarding the admission process to specifically examine and determine if current policies are helping facilitate the proper representation of minority students. Papers were selected on the basis of their relevance to the topic of underrepresented minority students and medical school admission policies and were limited to the years between 1987 and 1998. Each paper was individually evaluated on the basis of its study design and soundness of its contribution to the field. SUMMARY: The articles are organized under 4 major themes: Cognitive factors (mostly Medical College Admission Test scores and grade point average), noncognitive factors (e.g., leadership ability, interpersonal skills, motivation), the admission interview, and enrichment programs. Table 1 briefly summarizes these constituent articles. CONCLUSION: It was found that the body of literature is inadequately small and heterogeneous with regard to study design and results. A concerted effort must be made across medical education to correct the deficiencies in this particular area.

Efferent connections of the pulvinar nucleus in the cat.

Discrete unilateral electrolytic lesions were placed in the pulvinar nucleus of cats using the stereotaxic approach. The pathways of the degenerated fibres and their terminals were traced to the cerebral cortex and to subcortical nuclei by the method of Fink-Heimer (anterograde degeneration). The cortical projection sites of the pulvinar are the following: suprasylvian cortex, lateral cortex, ectosylvian cortex, cingulate gyrus, area postsubicularis and retrosplenial gyrus. However, the bulk of the cortical projections of the pulvinar nucleus were to mid- and posterior gyri of the suprasylvian cortex. In this study subcortical projections of the pulvinar have been seen to terminate in the superior colliculus, pretectal area, and the following thalamic nuclei: posterior, suprageniculate, dorsolateral, posterolateral, reticular, centromedian, centrolateral, parafascicular and dorsomedial. One of the purposes of this study was to explore possible anatomical connections of the pulvinar that might explain its presumed role in the pain mechanisms. The results of the present study, on subcortical connections of the pulvinar, provide a possible anatomical substrate for such a role where connections of the pulvinar to one or more of the thalamic nuclei implicated in pain mechanisms, the reticular, the intralaminar (centromedian, centrolateral and parafascicular) and the posterior could constitute the necessary anatomical pathway or pathways. Furthermore, the extensive projections of the pulvinar to several cortical regions including the cingulate gyrus could represent another means by which the pulvinar might influence cortical and limbic structures which are known to modify pain sensation.

Do underrepresented minority medical students differ from non-minority students in problem-solving ability?

BACKGROUND: In medical education, examinations must assess a logical progression toward problem-solving skills. Differences in cognitive development between underrepresented minority students (URMs) and non-URMs may affect examination performance and subsequent attrition rates. PURPOSE: The authors investigated URM and non-URM performances by retrospectively analyzing success rates on exam items of differing cognitive demand. METHOD: Mean correct responses to exam items classified as Recall, Interpretation, or Problem-Solving questions were calculated. Both URM and non-URM groups were stratified by grade point average (GPA) and scores on the Medical College Admission Test (MCAT). Differences were investigated with analysis of variance and general linear models. RESULTS: For all students, performance levels decreased as the cognitive demands of the exam items increased. When stratified by GPA and MCAT score, several important differences were found between URM and non-URM performance. CONCLUSIONS: Because cognitive measures fail to account for the majority of performance differences, noncognitive attributes must contribute to the poorer performance of URMs.

Performance of men and women medical students at King Saud University, Riyadh: a 10-year retrospective study.

This study was carried out using the results of medical students at the College of Medicine at King Saud University, Riyadh between 1975 and 1985. The purpose of the study was to ascertain whether any correlation existed between school performance and college performance, whether results from males were different from results from females, and whether the semester system, in operation since 1981, produced different results from the annual system. Significant correlations were found between school Grade Point Average (GPA) results and college results, being highest for premedical courses and lowest for clinical courses. However, these correlations were too small to be of practical use. Men students were found to perform better at preclinical subjects whereas women had better results at clinical subjects. The overall performance on the semester system was significantly higher than that on the annual system.

Application of "VITALS": visual indicators of teaching and learning success in reporting student evaluations of clinical teachers.

CONTEXT: At the College of Medicine and Medical Sciences, Arabian Gulf University, Bahrain, a system has been introduced in which clerkship students evaluate clinical faculty using Visual Indicators of Teaching and Learning Success (VITALS). OBJECTIVE: To describe the use of VITALS in reporting student feedback on teaching and learning effectiveness of clinical faculty in the clerkship. DESIGN: Descriptive study. SUBJECTS: A total of 210 clerkship students evaluated 76 clinical tutors over a period of 3 years. Feedback was also obtained from seven programme managers and one supportive staff member. METHOD: Nine indicators of effective clinical teaching were identified through a literature search. Students individually reported on clinical faculty teaching capabilities using a 5-point, Likert-type scale. Cumulative reports of students' feedback on clinical faculty teaching were prepared using opposing bar graphs, reflecting perceived areas of strength or weakness in each teacher's performance. RESULTS: A total of 1450 evaluation forms were completed by 180 of 210 students (85.7%). VITALS graph representations of students' perceptions of clinical tutors were communicated to each clinical tutor at the end of each clerkship and academic year. Twenty-one students out of 53 who gave written comments were related to VITALS. They reflected a positive view of VITALS as a process or tool of faculty evaluation. Clinical faculty (18), programme managers(7) and supporting staff (1) gave comments indicating acceptance of the system. CONCLUSION: This preliminary study suggests that VITALS could be an effective tool for improving clinical teaching. It is acceptable to students, faculty and managers of educational programmes. The database reflecting their teaching and educational profiles were used to provide clinical faculty with constructive feedback.