Do OSCE assessments reflect clinical maturation of medical students? An evaluation of progression in core knowledge and competency domains

Introduction/Background Application of knowledge in clinical settings can be assessed using several different methods. However, constructing an effective evaluation system for an educational program is a challenging task. Purpose/Objectives In this study, we aimed to evaluate our medical curriculum by investigating medical students' progressive acquisition of core clinical competencies in their clinical years, using domain-based and behaviourally anchored checklist and global rating scales in the OSCE format. Issues/Questions for exploration/Methodology Three collaboratively developed OSCE cases were administered in the 2012 end of year OSCEs to all 3rd, 4th and 5th year medical students. These OSCEs assessed core clinical competencies Year of study effect on checklist and global scores as well as competency scores were analysed using the multivariate analysis of variance. Results Irrespective of year of study, the results showed similar patterns in student performance across the three OSCE stations. However, performance was significantly affected by year of study (p<0.01) and case difficulty (p<0.001). Discussion There was a progressive increase in performance, with the more senior students obtaining higher checklist and global scores. They also demonstrated better performance in more complex clinical skills such as diagnostic skills and investigation plan. Conclusions The use of domain-based and behaviourally anchored checklist and global rating scales enhance the validity of the OSCE in measuring progressive clinical competence. It also enables identification of problem areas and provides feedback to faculty on the efficacy of the curriculum

Updating and validating quality prescribing indicators for use in Australian general practice

© 2019 La Trobe University. This study aims to update and validate quality prescribing indicators (QPIs) for Australian general practice. The study comprised two phases: (1) developing preliminary potential QPIs based on the 2006 National Prescribing Service (NPS) MedicineWise indicators, published literature, international indicators and guidelines, and through qualitative focus group discussions; and (2) validating the proposed QPIs through a two-round online survey using the Delphi technique. The Delphi panel included four GPs, four pharmacists and two clinical pharmacologists. The Delphi panel rated the potential QPIs for their validity, importance and feasibility using a 1-10 Likert scale. In round one, all proposed QPIs presented as 'prescribing rules' achieved high scores regarding validity, importance and feasibility No rule was eliminated and three new rules were introduced. Rules were reworded into 'prescribing indicators' for round two, which resulted in 35 indicators being accepted and two indicators being eliminated. The final QPIs also include seven drug-drug interactions, which received high scores in round one. In conclusion, 42 QPIs were nominated for use in Australian general practice, based on their validity, importance and feasibility. If implemented, these QPIs have the potential to assist in efforts to improve the quality and safety of medicines management

Health and Well-being of International University Students, and Comparison with Domestic Students in Tasmania Australia

International students comprise an increasingly larger proportion of higher education students globally. Empirical evidence about the health and well-being of these students is, however, limited. We sought to examine the health and well-being of international students, primarily from Asian countries, attending the University of Tasmania, Australia, using domestic students as a comparison group. Ethics approval was given to invite (via email) all currently enrolled students to participate in the study by completing a pilot-tested, online survey. The survey was completed by 382 international students (response rate = 8.9%) and 1013 domestic students (9.2%). Independent samples t-tests, analysis of variance (ANOVA) and chi-square tests were used for bivariate comparisons between international and domestic students, and between subgroups of international students. Regression models were used to examine the associations between student status (international vs. domestic) and health outcomes, controlling for demographic and enrolment variables. International students, particularly male students, were found to be at increased risk of several adverse health outcomes while also being less likely to seek help for mental health and related problems. The findings indicate the need for accessible, targeted, culturally-sensitive health promotion and early intervention programs

Characterising non-linear associations between airborne pollen counts and respiratory symptoms from the AirRater smartphone app in Tasmania, Australia: A case time series approach.

Pollen is a well-established trigger of asthma and allergic rhinitis, yet concentration-response relationships, lagged effects, and interactions with other environmental factors remain poorly understood. Smartphone technology offers an opportunity to address these challenges using large, multi-year datasets that capture individual symptoms and exposures in real time. We aimed to characterise associations between six pollen types and respiratory symptoms logged by users of the AirRater smartphone app in Tasmania, Australia. We analyzed 44,820 symptom reports logged by 2272 AirRater app users in Tasmania over four years (2015-2019). With these data we evaluated associations between daily respiratory symptoms and atmospheric pollen concentrations. We implemented Poisson regression models, using the case time series approach designed for app-sourced data. We assessed potentially non-linear and lagged associations with (a) total pollen and (b) six individual pollen taxa. We adjusted for seasonality and meteorology and tested for interactions with particulate air pollution (PM2.5). We found evidence of non-linear associations between total pollen and respiratory symptoms for up to three days following exposure. For total pollen, the same-day relative risk (RR) increased to 1.31 (95% CI: 1.26-1.37) at a concentration of 50 grains/m3 before plateauing. Associations with individual pollen taxa were also non-linear with some diversity in shapes. For all pollen taxa the same-day RR was highest. The interaction between total pollen and PM2.5 was positive, with risks associated with pollen significantly higher in the presence of high concentrations of PM2.5. Our results support a non-linear response between airborne pollen and respiratory symptoms. The association was strongest on the day of exposure and synergistic with particulate air pollution. The associations found with Dodonaea and Myrtaceae highlight the need to further investigate the role of Australian native pollen types in allergic respiratory disease

Promoting clinical reasoning in general practice trainees:role of the clinical teacher

BACKGROUND: Clinical reasoning requires knowledge, cognition and metacognition, and is contextually bound. Clinical teachers can and should play a key role in explicitly promoting clinical reasoning. CONTEXT: The aim of this article is to relate the clinical reasoning literature to the general practice or family medicine context, and to provide clinical teachers with strategies to promote clinical reasoning. INNOVATION: It is important that the clinical teacher teaches trainees the specific skills sets of the expert general practitioner (e.g. synthesising skills, recognising prototypes, focusing on cues and clues, using community resources and dealing with uncertainty) in order to promote clinical reasoning in the context of general practice or family medicine. Clinical teachers need to understand their own reasoning processes as well as be able to convey that knowledge to their trainees. They also need to understand the developmental stages of clinical reasoning and be able to nurture each trainee\u27s own expertise. Strategies for facilitating effective clinical reasoning in trainees include adequate exposure to patients, offering the trainees opportunity for reflection and feedback, and coaching on the techniques of reasoning in the general practice context. IMPLICATIONS: The journey to expertise in clinical reasoning is unique to each clinician, with different skills developing at different rates, depending on content, context and past experience. Doctors enter into general practice training with the building blocks of biomedical and clinical knowledge and a desire to learn how to be a general practitioner. Clinical teachers are integral in the process of helping trainees learn how to \u27think like a general practitioner\u27

Remediation for professional performance: the ALSO (Additional Learning Support Opportunities) program

Introduction/Background: Quality and safety outcomes demand that remediation does more than enable students to pass examinations. Given the limitations on faculty time and funding for remediation, it is important to encourage students to become masters of their own learning. \ud \ud Purpose/Objectives: This study investigated the effectiveness of an innovative remediation program which was based on socio-cognitive theory with an emphasis on self-efficacy to improve academic and clinical performance of underperforming medical students. \ud \ud Issues/Questions for exploration/methodology: Interventions were multi-faceted and composed of a wide range of group activities. The efficacy of the intervention program was evaluated using mixed-method approach consisting of semi-structured interviews, questionnaire (using a Likert scale and open ended questions) and quantitative analysis of OSCE outcomes (pre and post intervention). \ud \ud Results: Students demonstrated significant improvements across 3 of the 5 domains measured in OSCE performance (management, diagnosis and communication), with some variance between domestic and international students. Self-efficacy beliefs were markedly increased post-intervention. \ud \ud Discussion: Subsequent qualitative data suggests that beyond summative exam results, gains were translated to the clinical context with enhanced confidence and self-belief, enabling perceived improved performance in the workplace. \ud \ud Conclusions: Multi-dimensional, group orientated remediation which enhances self-efficacy beliefs improves outcomes for students in both high stakes assessment and in the clinical context, thus allowing translational and longitudinal benefits

Impact of self-efficacy beliefs on short- and long-term academic improvements for underperforming medical students

This study investigated the effectiveness of an innovative remediation program, based on promoting self-efficacy, a construct of self-regulation theory, which was developed to provide sustainable improvements in academic and clinical performance of underperforming medical students. Eighteen medical (eight 4th and ten 5th year) students participated in the remediation program. Interventions were multi-faceted and composed of a wide range of group activities. The efficacy of the intervention was evaluated using mixed-method approach consisting of interviews, questionnaire and quantitative analysis of OSCE outcomes (pre and post intervention). The in-depth interviews were used to explore the short- and long-term causal effects of the remediation program on improved performance. Students demonstrated significant improvements across 3 of the 5 domains measured in OSCE performance (management, diagnosis and communication). There was a 44% improvement in number of stations passed by participants post-remediation (95% CI = -52.25 to -35.64; r = 0.82). Large effect sizes were obtained, indicating the substantive significance of the results. Self-efficacy beliefs were markedly increased post-intervention with the total score increasing from 33.52 (SD=4.9) points pre-remediation to 45.71 (SD=5.1) points post-remediation (95% CI = -14.52 to -9.83; p<0.001; r = 0.77). Subsequent qualitative data suggested that beyond summative exam results, gains were translated to the clinical context with enhanced confidence and self–belief, enabling perceived improved performance in the workplace. Multi-dimensional, group orientated remediation, which emphasises self-efficacy beliefs, may enhance outcomes for students in both high stakes assessment and in the clinical context, thus allowing translational and longitudinal benefits

What are the perceived learning needs of Australian general practice registrars for quality prescribing?

Abstract Background Little is known about the perceived learning needs of Australian general practice (GP) registrars in relation to the quality use of medicines (QUM) or the difficulties experienced when learning to prescribe. This study aimed to address this gap. Methods GP registrars' perceived learning needs were investigated through an online national survey, interviews and focus groups. Medical educators' perceptions were canvassed in semi-structured interviews in order to gain a broader perspective of the registrars' needs. Qualitative data analysis was informed by a systematic framework method involving a number of stages. Survey data were analysed descriptively. Results The two most commonly attended QUM educational activities took place in the workplace and through regional training providers. Outside of these structured educational activities, registrars learned to prescribe mainly through social and situated means. Difficulties encountered by GP registrars included the transition from hospital prescribing to prescribing in the GP context, judging how well they were prescribing and identifying appropriate and efficient sources of information at the point of care. Conclusions GP registrars learn to prescribe primarily and opportunistically in the workplace. Despite many resources being expended on the provision of guidelines, decision-support systems and training, GP registrars expressed difficulties related to QUM. Ways of easing the transition into GP and of managing the information 'overload' related to medicines (and prescribing) in an evidence-guided, efficient and timely manner are needed. GP registrars should be provided with explicit feedback about the process and outcomes of prescribing decisions, including the use of audits, in order to improve their ability to judge their own prescribing.</p

Learning global health: a pilot study of an online collaborative intercultural peer group activity involving medical students in Australia and Indonesia

Abstract Background There is limited research to inform effective pedagogies for teaching global health to undergraduate medical students. Theoretically, using a combination of teaching pedagogies typically used in \u2018international classrooms\u2019 may prove to be an effective way of learning global health. This pilot study aimed to explore the experiences of medical students in Australia and Indonesia who participated in a reciprocal intercultural participatory peer e -learning activity (RIPPLE) in global health. Methods Seventy-one third year medical students (49 from Australia and 22 from Indonesia) from the University of Tasmania (Australia) and the University of Nusa Cendana (Indonesia) participated in the RIPPLE activity. Participants were randomly distributed into 11 intercultural \u2018virtual\u2019 groups. The groups collaborated online over two weeks to study a global health topic of their choice, and each group produced a structured research abstract. Pre\u2014 and post-RIPPLE questionnaires were used to capture students\u2019 experiences of the activity. Descriptive quantitative data were analysed with Microsoft Excel and qualitative data were thematically analysed. Results Students\u2019 motivation to volunteer for this activity included: curiosity about the innovative approach to learning; wanting to expand knowledge of global health; hoping to build personal and professional relationships; and a desire to be part of an intercultural experience. Afer completing the RIPPLE program, participants reported on global health knowledge acquisition, the development of peer relationships, and insight into another culture. Barriers to achieving the learning outcomes associated with RIPPLE included problems with establishing consistent online communication, and effectively managing time to simultaneously complete RIPPLE and other curricula activities. Conclusions Medical students from both countries found benefits in working together in small virtual groups to complement existing teaching in global health. However, our pilot study demonstrated that while intercultural collaborative peer learning activities like RIPPLE are feasible, they require robust logistical support and an awareness of the need to manage curriculum alignment in ways that facilitate more effective student engagement

Linking basic science knowledge retention and perceived clinical relevance in a vertically integrated curriculum

Background: For medical students to apply clinical reasoning based on sound scientific principles, they must be able to retain basic science knowledge as they progress. However, when knowledge gained is not perceived as applicable to clinical contexts, it is less likely to be retained.\ud \ud Summary of work: We investigated the relationship between perceived clinical relevance and retention of basic science knowledge in Years 2-5 students through a 50-item multiple-choice question (MCQ) examination. Information was collected pertaining to demographics, prior educational experience, and the perceived clinical relevance of each question.\ud \ud Summary of results: A total of 232 students (response rate 50%) undertook the assessment task. Retention of basic science knowledge was significantly affected (p<0.001) by year of study, gender and student origin. There were increasingly positive correlations between items answered correctly and their perceived relevance from Years 2 to 5 (Year 2, r=0.040; Year 3, r=0.26; Year 4, r=0.36; Year 5, r=0.60).\ud \ud Conclusions: This study highlights the increasingly positive correlation between perceived clinical relevance and the retention of basic science knowledge with progression to more senior years. Strategies to promote the clinical relevance of teaching material to students may be critical to the retention of that knowledge and its ultimate transfer to the clinical context. Perceived relevance of a subject matter elicits deep learning and fosters retention of knowledge.\ud \ud Take-home messages: Basic science knowledge is more likely to be retained if students have a greater perception of its clinical relevance