A collaborative comparison of Objective Structured Clinical Examination (OSCE) standard setting methods at Australian medical schools

Background: A key issue underpinning the usefulness of the OSCE assessment to medical education is standard-setting, but the majority of standard-setting methods remain challenging for performance assessment because they produce varying passing marks. Several studies have compared standard setting methods; however, most of these studies are limited by their experimental scope, or use data on examinee performance at a single OSCE station or from a single medical school. This collaborative study between ten Australian medical schools investigated the effect of standard-setting methods on OSCE cut scores and failure rates. Methods: This research used 5,256 examinee scores from seven shared OSCE stations to calculate cut scores and failure rates using two different compromise standard-setting methods, namely the Borderline Regression and Cohen's methods. Results: The results of this study indicate that Cohen's method yields similar outcomes to the Borderline Regression method, particularly for large examinee cohort sizes. However, with lower examinee numbers on a station, the Borderline Regression method resulted in higher cut scores and larger difference margins in the failure rates. Conclusion: Cohen's method yields similar outcomes as the Borderline Regression method and its application for benchmarking purposes and in resource-limited settings is justifiable, particularly with large examinee numbers

A preliminary investigation to explore the cognitive resources of physicians experiencing difficulty in training

Background Treating patients is complex, and research shows that there are differences in cognitive resources between physicians who experience difficulties, and those who do not. It is possible that differences in some cognitive resources could explain the difficulties faced by some physicians. In this study, we explore differences in cognitive resources between different groups of physicians (that is, between native (UK) physicians and International Medical Graduates (IMG); those who continue with training versus those who were subsequently removed from the training programme); and also between physicians experiencing difficulties compared with the general population. Methods A secondary evaluation was conducted on an anonymised dataset provided by the East Midlands Professional Support Unit (PSU). One hundred and twenty one postgraduate trainee physicians took part in an Educational Psychology assessment through PSU. Referrals to the PSU were mainly on the basis of problems with exam progression and difficulties in communication skills, organisation and confidence. Cognitive resources were assessed using the Wechsler Adult Intelligence Scale (WAIS-IV). Physicians were categorised into three PSU outcomes: ‘Continued in training’, ‘Removed from training’ and ‘Active’ (currently accessing the PSU). Results Using a one-sample Z test, we compared the referred physician sample to a UK general population sample on the WAIS-IV and found the referred sample significantly higher in Verbal Comprehension (VCI; z = 8.78) and significantly lower in Working Memory (WMI; z = −4.59). In addition, the native sample were significantly higher in Verbal Comprehension than the UK general population sample (VCI; native physicians: z = 9.95, p < .001, d = 1.25), whilst there was a lesser effect for the difference between the IMG sample and the UK general population (z = 2.13, p = .03, d = 0.29). Findings also showed a significant difference in VCI scores between those physicians who were ‘Removed from training’ and those who ‘Continued in training’. Conclusions Our results suggest it is important to understand the cognitive resources of physicians to provide a more focussed explanation of those who experience difficulties in training. This will help to implement more targeted interventions to help physicians develop compensatory strategies

Mobile application intervention to promote self-management in insulin-requiring type 1 and type 2 diabetes individuals: protocol for a mixed methods study and non-blinded randomized controlled trial

Mary D Adu,1 Usman H Malabu,1 Aduli EO Malau-Aduli,2 Bunmi S Malau-Aduli11College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia; 2College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, AustraliaBackground: Mobile applications (apps) have proven to be useful in supporting diabetes self-care, but non-consideration of users&rsquo; needs and non-inclusion of educational features are reasons for low continual use. Well-designed mobile apps that meet the needs of diabetes patients and provide ongoing self-management education and support are required. It was hypothesized that apps designed with such features can improve a range of measures including clinical outcomes, knowledge of diabetes, medication adherence, perceived ability for self-management, and quality-of-life. This may eventually facilitate a more robust and cost-effective approach for improving skills and motivation for the management of diabetes.Methods: This project will be conducted in two phases. It will initially employ a mixed methods study design to investigate the self-management needs and perceptions of diabetes patients on the use of mobile apps to support diabetes self-management. Results of the mixed methods study will inform the content and design of an app which will be employed as an intervention tool in a 12-month parallel randomized controlled trial (RCT). The RCT will compare outcomes in relation to standard-of-care alone with standard-of-care plus a mobile phone diabetes app among 150 insulin-requiring types 1 and 2 diabetes patients. The primary outcome measures are clinical parameters such as hemoglobin A1c (HbA1c), lipids, urine albumin-to-creatinine ratio, blood pressure, frequency in events of emergency hyperglycemia and hypoglycemia. Secondary outcomes include knowledge of diabetes, medication intake and adherence, perception of self-care, and quality-of-life.Discussion: Results from this study will provide empirical evidence on the usefulness of a mobile app developed based on self-management needs analysis of diabetic patients. The long-term goal is to harness knowledge gained from this study to provide evidenced-based data, which promote the scale-up or adoption of mobile applications that provide regular, ongoing education and self-management support to people living with diabetes.Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12618000065291, Registered on 17 January, 2018 (prospectively registered).Keywords: randomized controlled trial, mixed methods design, diabetes, self-management education, mobile applicatio

Effect of supplementation on the milk yield and composition of Red Sokoto does

Twenty-eight Red Sokoto does were supplemented with crop residue-based and concentrate rations at 1 and 2% of body weight in a 7-treatment completely randomised block design experiment. Average daily milk yield, total milk yield, total lactation length and milk composition were monitored and subjected to least squares analysis to test the effect of treatment. Results indicated that Ration 1C which comprised of mainly crop residue with much lesser protein levels than the concentrate rations (1A and 2A), produced 54kg of milk over a 90-day lactation period averaging 0.60 kg per day. At the other extreme, the negative control ration (Green grass and Digitaria hay) contained the least protein and dams that fed on it had the shortest lactation length (41 days), and therefore least total and average daily milk yields (10.2 and 0.25kg, respectively). It was evident that in absolute terms, milk from does on Ration 2A contained the highest percentages of fat (6%), protein (6.33%), total solids (21.85%) and SNF (15.85%). As expected, milk from does on the negative control ration ranked least with respect to all the parameters studied. It was concluded that Ration C fed at 1% level is a good supplementary feed package for increased milk production in Red Sokoto goats because it competes favourably with conventional concentrate rations. It also gives milk with lower fat content than conventional concentrate rations which from a consumer point of view, is healthy and desirable

Pharmacy students' perceptions of assessment and its impact on learning

Introduction: Outcomes-based education requires active student learning with assessment strategies that foster deep approaches to learning, which are often influenced by students' perceptions of assessment. We aimed to investigate the perceptions of pharmacy students at an Australian university about their experiences of assessment and its impact on their learning. Methods: A mixed-methods study was conducted involving a self-administered questionnaire and semi-structured focus groups. Descriptive statistics were used to rate the perceived value of different assessment tools and confirmed by themes arising from the focus groups. Examination results over a five-year period were also collated to assess congruence between perceptions and academic performance. Results: From the 123 questionnaire and nine focus group participants, short-answer questions were the most positively-received form of assessment due to students being able to demonstrate and receive marks for partial knowledge. Multiple-choice questions received mixed response as they were cited as being useful in assessing student knowledge but potentially difficult to interpret/answer correctly. Reflective pieces received the lowest ratings and were considered the least beneficial. Key identified themes were ensuring quality assurance of assessment processes, use of authentic assessment, timely feedback, and appropriate match between workload and assessment weightings. Overall, there was congruence between students' exam scores and their perceptions of the different assessment types. Conclusions: Strategic planning and delivery of correctly-weighted authentic assessments with the provision of constructive feedback are key elements for active engagement of students and achievement of life-long learning outcomes. © 2019 Elsevier Inc

Retention of knowledge and perceived relevance of basic sciences in an integrated case-based learning (CBL) curriculum

Background: Knowledge and understanding of basic biomedical sciences remain essential to medical practice, particularly when faced with the continual advancement of diagnostic and therapeutic modalities. Evidence suggests, however, that retention tends to atrophy across the span of an average medical course and into the early postgraduate years, as preoccupation with clinical medicine predominates. We postulated that perceived relevance demonstrated through applicability to clinical situations may assist in retention of basic science knowledge.\ud \ud Methods: To test this hypothesis in our own medical student cohort, we administered a paper-based 50 MCQ assessment to a sample of students from Years 2 through 5. Covariates pertaining to demographics, prior educational experience, and the perceived clinical relevance of each question were also collected.\ud \ud Results: A total of 232 students (Years 2–5, response rate 50%) undertook the assessment task. This sample had comparable demographic and performance characteristics to the whole medical school cohort. In general, discipline-specific and overall scores were better for students in the latter years of the course compared to those in Year 2; male students and domestic students tended to perform better than their respective counterparts in certain disciplines. In the clinical years, perceived clinical relevance was significantly and positively correlated with item performance.\ud \ud Conclusions: This study suggests that perceived clinical relevance is a contributing factor to the retention of basic science knowledge and behoves curriculum planners to make clinical relevance a more explicit component of applied science teaching throughout the medical course