Examining the educational impact of the mini-CEX: a randomised controlled study

Background: The purpose of this study is to evaluate the mini-Clinical Evaluation Exercise (mini-CEX) as a formative assessment tool among undergraduate medical students, in terms of student perceptions, effects on direct observation and feedback, and educational impact. Methods: Cluster randomised study of 38 fifth-year medical students during a 16-week clinical placement. Hospitals were randomised to provide a minimum of 8 mini-CEXs per student (intervention arm) or continue with ad-hoc feedback (control arm). After finishing their clinical placement, students completed an Objective Structured Clinical Examination (OSCE), a written test and a survey. Results: All participants in the intervention group completed the pre-planned number of assessments, and 60% found them to be useful during their clinical placement. Overall, there were no statistically significant differences between groups in reported quantity or quality of direct observation and feedback. Observed mean scores were marginally higher on the OSCE and written test in the intervention group, but not statistically significant. Conclusions: There is considerable potential in assessing medical students during clinical placements and routine practice, but the educational impact of formative assessments remains mostly unknown. This study contributes with a robust study design, and may serve as a basis for future research

Silica crystals and aluminum salts activate the NALP3 inflammasome through phagosomal destabilization

Inhalation of silica crystals causes inflammation in the alveolar space. Prolonged exposure to silica can lead to the development of silicosis, an irreversible, fibrotic pulmonary disease. The mechanisms by which silica and other crystals activate immune cells are not well understood. Here we demonstrate that silica and aluminum salt crystals activated inflammasomes formed by the cytoplasmic receptor NALP3. NALP3 activation required phagocytosis of crystals, and this uptake subsequently led to lysosomal damage and rupture. \u27Sterile\u27 lysosomal damage (without crystals) also induced NALP3 activation, and inhibition of either phagosomal acidification or cathepsin B activity impaired NALP3 activation. Our results indicate that the NALP3 inflammasome senses lysosomal damage as an endogenous \u27danger\u27 signal

Improving assessment quality in professional higher education: Could external peer review be the answer?

Summative assessment in professional higher education is important for student learning and making sound decisions about advancement and certification. Despite rigorous pre-test quality assurance procedures, problematic assessment items are always discovered post-test. This article examines the implementation of external peer review of items by clinicians in a six-year undergraduate medical programme. The purpose of the article is to identify to what extent clinicians consider multiple choice items to be acceptable for use in examinations, and what comments they provide on items they believe should be revised or not be used at all. 170 clinicians were recruited and reviewed 1353 multiple choice questions. Results showed that one out of five items reviewed were not approved. There were three main reasons for not approving items: (i) relevance of item content, (ii) accuracy of item content and (iii) technical item writing flaws. The article provides insight into a promising quality assurance procedure suitable for in-house examinations in professional higher education