Group versus modified individual standard-setting on multiple-choice questions with the Angoff method for fourth-year medical students in the internal medicine clerkship

Vichai Senthong,1,* Jarin Chindaprasirt,1,* Kittisak Sawanyawisuth,1 Noppadol Aekphachaisawat,2 Suteeraporn Chaowattanapanit,1 Panita Limpawattana,1 Charoen Choonhakarn,1 Aumkhae Sookprasert1 1Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 2Central Library, Silpakorn University, Bangkok, Thailand *These authors contributed equally to this work Background: The Angoff method is one of the preferred methods for setting a passing level in an exam. Normally, group meetings are required, which may be a problem for busy medical educators. Here, we compared a modified Angoff individual method to the conventional group method. Methods: Six clinical instructors were divided into two groups matched by teaching experience: modified Angoff individual method (three persons) and conventional group method (three persons). The passing scores were set by using the Angoff theory. The groups set the scores individually and then met to determine the passing score. In the modified Angoff individual method, passing scores were judged by each instructor and the final passing score was adjusted by the concordance method and reliability index. Results: There were 94 fourth-year medical students who took the test. The mean (standard deviation) test score was 65.35 (8.38), with a median of 64 (range 46–82). The three individual instructors took 45, 60, and 60 minutes to finish the task, while the group spent 90 minutes in discussion. The final passing score in the modified Angoff individual method was 52.18 (56.75 minus 4.57) or 52 versus 51 from the standard group method. There was not much difference in numbers of failed students by either method (four versus three). Conclusion: The modified Angoff individual method may be a feasible way to set a standard passing score with less time consumed and more independent rather than group work by instructors. Keywords: Angoff, individual, passing score, standard-setting, multiple-choice questions, internal medicin

The synergistic effect of minimal amounts of long-wavelength ultraviolet A1 and visible light on pigmentation

Visible light has been shown to induce dark and persistent pigmentation in addition to erythema, thermal damage, and free radical production. The pigmentation phases include immediate pigment darkening (IPD), persistent pigment darkening (PPD), and delayed tanning (DT) that occur immediately, between 2-24 hours, and 3-5 days after irradiation respectively. Variations in spectral outputs of light sources can lead to differences in visible light induced pigmentation responses. The study aimed at investigating the synergistic effect of minimal amounts of long-wavelength ultraviolet A1 (UVA1) radiation and visible light on pigmentation and erythema response. Subjects with Fitzpatrick skin phototype IV-VI were recruited. On day 0, subjects were irradiated on either side of their back with a dose of visible light using two different light sources; one containing pure visible light while the other containing visible light with trace amounts of long wavelength UVA1. Evaluations were performed immediately (to assess IPD), 24 hours (to assess PPD), 7 days (to assess DT), and 14 days (to assess DT) after irradiation. Assessment methods included investigator\u27s global assessment (IGA), clinical photography, and spectroscopy. IPD, PPD and DT responses were observed with both light sources. However, the intensity of the pigmentation was approximately two times greater when subjects were irradiated with the light source containing trace amounts of UVA1 along with visible light compared to that with pure visible light alone. In conclusion, pure visible light induces pigmentation. The degree of this pigmentation is significantly enhanced by the presence of trace amount of UVA1 light. This suggests the necessity for development of sunscreens and other mechanisms to provide photo-protection against this part of the solar spectrum

The effect of topical sunscreen plus antioxidant against the visible light biologic effects.

Background: Visible light (VL) has been shown to induce erythema, pigmentation, and photodamage. Sunscreens effective against VL contain inorganic filters, but are often cosmetically unacceptable in darker skin tones. Antioxidants possess photoprotective properties and may serve as an alternative. Objective: To investigate the synergistic effect of sunscreen plus antioxidant (SA) against the visible light biologic effects. Methods: 29 subjects with Fitzpatrick skin type IV-VI had topical application of sunscreen plus antioxidant (SA), topical sunscreen containing physical blockers (SP), and topical antioxidant (A) before VL exposure. The pigmentation response was compared with subject’s baseline VL response. Investigator’s global assessment scores, photography, and diffuse reflectance spectroscopy were performed immediately after VL exposure to assess immediate pigment darkening (IPD), at 24 hours to assess persistent pigment darkening (PPD), and 7 days after to assess delayed tanning (DT). Results: Clinically, a decrease in IGA score for pigmentation was observed for sites treated with SA, and for SP compared with that of the control, although statistical significance was not reached. Spectroscopic data showed a statistically significant decrease in IPD, PPD, and DT response after application of SP compared with control ( P \u3c .05). In addition, SA reduced PPD ( P \u3c .05) but not DT. Conclusions: A combination product of SA or SP appears to be effective in decreasing the VL-induced persistent pigment darkening response. In addition, SP was able to reduce pigmentation at the IPD and DT time points based on spectroscopic results, suggesting protection offered against VL-induced effects

Oral Polypodium leucotomos extract and its impact on visible light–induced pigmentation.

Background: Visible light has multiple effects on the skin including erythema, DNA damage secondary to free radical production, and pigmentation. Few sunscreens protect against visible light, which can exacerbate photodermatoses. Polypodium leucotomos extract (PLE) has antioxidant, photoprotective, chemoprotective, antiinflammatory, and immunomodulatory properties that may offer protection against visible light induced effects. Objective: To determine the effectiveness of PLE in preventing visible light–induced pigmentation. Methods: 20 subjects with Fitzpatrick SPT IV-VI have been completed. On day 0, subjects were irradiated with visible light. Evaluation occurred immediately, 24 hours, and 7 days after irradiation. Subjects then received a 28 day supply of PLE. Irradiation and evaluation were repeated on days 35, 36, and 42. Pigmentation was assessed by investigator’s global assessment, clinical photography, diffuse reflectance spectroscopy, and biopsies. Results: All subjects had an immediate pigment darkening (IPD), persistent pigment darkening (PPD), and delayed tanning (DT) response both before and after PLE. However, at a dose of 480 J/cm 2 , there was a statistically significant decrease in PPD and DT after administration of PLE based on spectroscopy. There was a trend toward a decrease in the markers for oxidative damage and inflammation after administration of PLE. Conclusions: Spectroscopic assessments and histology indicate an effect of PLE on visible light induced pigmentation and cellular damage. This has important implications for the improvement of photoprotection and prevention of cutaneous malignancies

Synergistic effects of long-wavelength ultraviolet A1 and visible light on pigmentation and erythema

Background: Visible light (VL) induces multiple cutaneous effects including dark and persistent pigmentation in addition to erythema, thermal damage, and free radical production. Sunscreen testing protocols recommended by regulatory bodies throughout the world require the use of solar simulators with spectral output in ultraviolet (UV) domain only. However, sunlight contains VL and infrared radiation also. Objective: This study aimed to evaluate the contributions of VL and UVA1 on pigmentation and erythema, and optimize parameters for in vivo testing. Methods: Ten subjects with Fitzpatrick skin phototype IV-VI were enrolled. Subjects were irradiated on their back with VL using 2 light sources: 1 containing pure VL and 1 containing VL with \u3c0.5% UVA1 (VL+UVA1). Four different irradiances were administered to investigate reciprocity behavior which states that a response is directly proportional to the dose, a product of irradiance and exposure time, and independent from the individual values of the 2. Assessments, including photography, investigator’s global assessment, colorimetry, and spectroscopy, were performed immediately, 24 hours, 7 days, and 14 days after irradiation. Results: Pigmentation was observed with both light sources; however, pigment intensity was greater with VL+UVA1 than pure VL. Reciprocity was observed in pure VL sites, but not VL+UVA1. Variation in spectral output had greater impact on pigment intensity than irradiance. Clinical erythema was observed on the VL+UVA1 side, but not on the pure VL side. Protocol for testing photoprotection product efficacy against VL induced effects has been proposed. Conclusions: The findings suggest a synergistic relationship between VL and UVA1 and emphasize the need for developing means of photoprotection against VL

Synergistic effects of long-wavelength ultraviolet A1 and visible light on pigmentation and erythema

BACKGROUND: Visible light (VL) induces multiple cutaneous effects. Sunscreen testing protocols recommended by regulatory bodies throughout the world require the use of solar simulators with spectral output in the ultraviolet (UV) domain only. However, sunlight contains VL and infrared radiation also. OBJECTIVES: This study aimed to evaluate the contributions of VL and UVA on pigmentation and erythema, and optimize parameters for in vivo testing. METHODS: Ten subjects with Fitzpatrick skin phototype IV-VI were enrolled. Subjects were irradiated on their back with VL using two light sources: one containing pure VL and one containing VL with less than 0·5% UVA1 (VL+UVA1). Four different irradiances were administered to investigate reciprocity behaviour. Assessments, including photography, Investigator\u27s Global Assessment, colorimetry and spectroscopy, were performed immediately, 24 h, 7 days and 14 days post-irradiation. RESULTS: Pigmentation was observed with both light sources; however, pigment intensity was greater with VL+UVA1 than with pure VL. Reciprocity was observed in pure VL sites, but not VL+UVA1. Variation in spectral output had greater impact on pigment intensity than irradiance. Clinical erythema was observed on the VL+UVA1 side, but not on the pure VL side. A protocol for testing photoprotection product efficacy against VL-induced effects has been proposed. CONCLUSIONS: The findings suggest a synergistic relationship between VL and UVA1 and emphasize the need for developing means of photoprotection against VL