Correlation between different PBL assessment components and the final mark for MB ChB III at a rural South African university

Background. Problem-based learning (PBL) is now an accepted component of many medical school programmes worldwide. Our university also follows the PBL ‘SPICES’ model for MB ChB III. The assessment modalities used are the modified essay questions (MEQ), objective structured practical examination (OSPE), individualised process assessment (IPA) and tutorial continuous assessment (TUT). This study was done to compare the students’ performances in individual assessment components with the final mark to determine the correlation between these parameters. Materials and methods. The study was retrospective, descriptive and analytical, based on the integrated marks of all the MB ChB III students at Walter Sisulu University (WSU) in 2007. Assessment marks were stratified according to blocks and different types of assessment (MEQ, TUT, OSPE, IPA). Regression analysis was used to compute and scrutinise these vis-à-vis their correspondence with the final marks for each block. Results. Three hundred and seventy-nine block assessment marks of 96 students from 4 blocks of MB ChB III were analysed and the correlation between the assessment components and final mark were compared. Regression analysis showed good correlation when analysing the assessment modality versus the final mark for the MEQs (r=0.93, 0.93, 0.94, 0.96), followed by OSPEs (r=0.71, 0.70, 0.76, 0.77) and IPAs (r=0.62, 0.51, 0.68, 0.77). However, correlation was not significant with the TUT. Conclusion. There was good correlation between the students’ performance in the majority of assessment modalities and the final mark in the different blocks of the MB ChB III examination. There may be a need to make tutorial assessment methods more objective, partly by additional tutor training

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Students' and junior doctors' preparedness for the reality of practice in sub-Saharan Africa

Item does not contain fulltextBACKGROUND: Evidence tailored to sub-Saharan Africa on outcomes of innovations in medical education is needed to encourage and advance their implementation in this region. AIM: To investigate preparedness for practice of students and graduates from an innovative and a conventional medical curriculum in a sub-Saharan African context. METHODS: Using mixed methods we compared junior doctors and fifth-year students from two Mozambican medical schools: one with an innovative problem- and community-based curriculum and one with a conventional lecture- and discipline-based curriculum. A questionnaire on professional competencies was administered, semi-structured interviews were conducted, and work diaries were collected. The findings were integrated in a conceptual model. RESULTS: Six areas of tension between global health care ideals and local health care practice emerged from the data that challenged doctors' motivation and preparedness for practice. Four elements of the innovative curriculum equipped students and graduates with skills, attitudes and competencies to better cope with these tensions. Students and graduates from the innovative curriculum rated significantly higher levels on various competencies and expressed more satisfaction with the curriculum and its usefulness for their work. CONCLUSION: An innovative problem- and community-based curriculum can improve sub-Saharan African doctors' motivation and preparedness to tackle the challenges of health care practice in this region