Does Medical Students' Preference of Test Format (Computer-based vs. Paper-based) have an Influence on Performance?

<p>Abstract</p> <p>Background</p> <p>Computer-based examinations (CBE) ensure higher efficiency with respect to producibility and assessment compared to paper-based examinations (PBE). However, students often have objections against CBE and are afraid of getting poorer results in a CBE.</p> <p>The aims of this study were (1) to assess the readiness and the objections of students to a CBE vs. PBE (2) to examine the acceptance and satisfaction with the CBE on a voluntary basis, and (3) to compare the results of the examinations, which were conducted in different formats.</p> <p>Methods</p> <p>Fifth year medical students were introduced to an examination-player and were free to choose their format for the test. The reason behind the choice of the format as well as the satisfaction with the choice was evaluated after the test with a questionnaire. Additionally, the expected and achieved examination results were measured.</p> <p>Results</p> <p>Out of 98 students, 36 voluntarily chose a CBE (37%), 62 students chose a PBE (63%). Both groups did not differ concerning sex, computer-experience, their achieved examination results of the test, and their satisfaction with the chosen format. Reasons for the students' objections against CBE include the possibility for outlines or written notices, a better overview, additional noise from the keyboard or missing habits normally present in a paper based exam. The students with the CBE tended to judge their examination to be more clear and understandable. Moreover, they saw their results to be independent of the format.</p> <p>Conclusions</p> <p>Voluntary computer-based examinations lead to equal test scores compared to a paper-based format.</p

Evidence for Distinguishable Treatment Costs among Paranoid Schizophrenia and Schizoaffective Disorder.

Schizophrenia spectrum disorders result in enormous individual suffering and financial burden on patients and on society. In Germany, there are about 1,000,000 individuals suffering from schizophrenia (SZ) or schizoaffective disorder (SAD), a combination of psychotic and affective symptoms. Given the heterogeneous nature of these syndromes, one may assume that there is a difference in treatment costs among patients with paranoid SZ and SAD. However, the current the national system of cost accounting in psychiatry and psychosomatics in Germany assesses all schizophrenia spectrum disorders within one category.The study comprised a retrospective audit of data from 118 patients diagnosed with paranoid SZ (F20.0) and 71 patients with SAD (F25). We used the mean total costs as well as partial cost, i.e., mean costs for medication products, mean personal costs and mean infrastructure costs from each patient for the statistical analysis. We tested for differences in the four variables between SZ and SAD patients using ANCOVA and confirmed the results with bootstrapping.SAD patients had a longer duration of stay than patients with SZ (p = .02). Mean total costs were significantly higher for SAD patients (p = .023). Further, we found a significant difference in mean personnel costs (p = .02) between patients with SZ and SAD. However, we found no significant differences in mean pharmaceutical costs (p = .12) but a marginal difference of mean infrastructure costs (p = .05) between SZ and SAD. We found neither a common decrease of costs over time nor a differential decrease in SZ and SAD.We found evidence for a difference of case related costs of inpatient treatments for paranoid SZ and SAD. The differences in mean total costs seem to be primarily related to the mean personnel costs in patients with paranoid SZ and SAD rather than mean pharmaceutical costs, possibly due to higher personnel effort and infrastructure

Electronic acquisition of OSCE performance using tablets

Background: Objective Structured Clinical Examinations (OSCEs) often involve a considerable amount of resources in terms of materials and organization since the scores are often recorded on paper. Computer-assisted administration is an alternative with which the need for material resources can be reduced. In particular, the use of tablets seems sensible because these are easy to transport and flexible to use.Aim: User acceptance concerning the use of tablets during OSCEs has not yet been extensively investigated. The aim of this study was to evaluate tablet-based OSCEs from the perspective of the user (examiner) and the student examinee.Method: For two OSCEs in Internal Medicine at the University of Heidelberg, user acceptance was analyzed regarding tablet-based administration (satisfaction with functionality) and the subjective amount of effort as perceived by the examiners. Standardized questionnaires and semi-standardized interviews were conducted (complete survey of all participating examiners). In addition, for one OSCE, the subjective evaluation of this mode of assessment was gathered from a random sample of participating students in semi-standardized interviews.Results: Overall, the examiners were very satisfied with using tablets during the assessment. The subjective amount of effort to use the tablet was found on average to be “hardly difficult”. The examiners identified the advantages of this mode of administration as being in particular the ease of use and low rate of error. During the interviews of the examinees, acceptance for the use of tablets during the assessment was also detected.Discussion: Overall, it was found that the use of tablets during OSCEs was well accepted by both examiners and examinees. We expect that this mode of assessment also offers advantages regarding assessment documentation, use of resources, and rate of error in comparison with paper-based assessments; all of these aspects should be followed up on in further studies

Average daily costs in Euro of inpatient treatment of patients with paranoid SZ (blue-green graphs) and SAD (red-yellow).

<p>The timeline does not represent a calendar period of one year but a transformation where all individual treatment courses start at day one of the presented timeline. Note that the number of averaged cases decreases over time. with less than 5 patients received longer treatments than 154 days (i.e. for 167, 180, 183 and 253 days respectively). This results in higher fluctuations of daily means.</p

Mean values of personal, medication and infrastructure costs per case in Euro for patients with paranoid SZ (blue) and SAD (red).

<p>The ends of the whiskers indicate the standard deviation. Note that these partial costs do not exactly add up to the amount of total costs, since we did not compare costs for materials other than medication.</p

Demographic characteristics and costs (<i>n</i> = 189).

<p>Demographic characteristics and costs (<i>n</i> = 189).</p

Good exams made easy: The item management system for multiple examination formats

<p>Abstract</p> <p>Background</p> <p>The development, implementation and evaluation of assessments require considerable resources and often cannot be carried out by a single faculty/institution. Therefore some medical faculties have founded cooperation projects which mainly focus on the exchange of multiple choice questions (MCQs).</p> <p>Methods</p> <p>Since these cooperation projects do not entirely support all relevant processes in terms of preparation, implementation and evaluation of assessment, in 2006 the Medical Assessment Alliance (MAA) was founded for mutual support. In addition to MCQs the MAA started to develop innovative assessment formats and facilitate content through a coordinated exchange of experiences. To support cooperation within this network, the web-based Item Management System (IMS) was developed which supports all processes of the assessment workflow as an all-in-one working platform.</p> <p>Results</p> <p>At present, the Alliance has 28 partner faculties in Europe. More than 2.800 users in 750 working groups are collaborating. Currently 90.000 questions have been stored in the IMS. Since 2007, nearly 4.600 examinations have been successfully conducted.</p> <p>Conclusion</p> <p>This article describes in detail the unique features of the IMS and contrasts it with the item management systems of other associations.</p

Interaction of mental comorbidity and physical multimorbidity predicts length-of-stay in medical inpatients

Background Mental comorbidities of physically ill patients lead to higher morbidity, mortality, health-care utilization and costs. Objective The aim of the study was to investigate the impact of mental comorbidity and physical multimorbidity on the length-of-stay in medical inpatients at a maximum-care university hospital. Design The study follows a retrospective, quantitative cross-sectional analysis approach to investigate mental comorbidity and physical multimorbidity in internal medicine patients. Patients The study comprised a total of n = 28.553 inpatients treated in 2017, 2018 and 2019 at a German Medical University Hospital. Main measures Inpatients with a mental comorbidity showed a median length-of-stay of eight days that was two days longer compared to inpatients without a mental comorbidity. Neurotic and somatoform disorders (ICD-10 F4), behavioral syndromes (F5) and organic disorders (F0) were leading with respect to length-of-stay, followed by affective disorders (F3), schizophrenia and delusional disorders (F2), and substance use (F1), all above the sample mean length-of-stay. The impact of mental comorbidity on length-of-stay was greatest for middle-aged patients. Mental comorbidity and Elixhauser score as a measure for physical multimorbidity showed a significant interaction effect indicating that the impact of mental comorbidity on length-of-stay was greater in patients with higher Elixhauser scores. Conclusions The findings provide new insights in medical inpatients how mental comorbidity and physical multimorbidity interact with respect to length-of-stay. Mental comorbidity had a large effect on length-of-stay, especially in patients with high levels of physical multimorbidity. Thus, there is an urgent need for new service models to especially care for multimorbid inpatients with mental comorbidity

Assessing the prognoses on Health care in the information society 2013--thirteen years after

Health care and information technology in health care is advancing at tremendous speed. We analysed whether the prognoses by Haux et al. - first presented in 2000 and published in 2002 - have been fulfilled in 2013 and which might be the reasons for match or mismatch. Twenty international experts in biomedical and health informatics met in May 2013 in a workshop to discuss match or mismatch of each of the 71 prognoses. After this meeting a web-based survey among workshop participants took place. Thirty-three prognoses were assessed matching; they reflect e.g. that there is good progress in storing patient data electronically in health care institutions. Twenty-three prognoses were assessed mismatching; they reflect e.g. that telemedicine and home monitoring as well as electronic exchange of patient data between institutions is not established as widespread as expected. Fifteen prognoses were assessed neither matching nor mismatching. ICT tools have considerably influenced health care in the last decade, but in many cases not as far as it was expected by Haux et al. in 2002. In most cases this is not a matter of the availability of technical solutions but of organizational and ethical issues. We need innovative and modern information system architectures which support multiple use of data for patient care as well as for research and reporting and which are able to integrate data from home monitoring into a patient centered health record. Since innovative technology is available the efficient and wide-spread use in health care has to be enabled by systematic information managemen