The Reliability, Validity, and Student Perceptions of an Undergraduate Research Program in Health Sciences (BHSc) as a Premedical Program: A Preliminary Study

The purpose of this study was to investigate the reliability and validity of the admission process for an undergraduate research program in health science and to assess the students’ statement of purpose for entering the program. Admission data (high school marks, supplementary application information, and overall rater score) and first-year GPA were analyzed for the 2003-2004 inaugural class (n=55, mean age 17.9 [SD 1.0] years, 61.8% female and 38.2% male). Although the stated purpose of the program is to educate future health researchers, nearly half (43.6%) indicated that their reason for entering the program was to help them to gain admission to medical school. Final high school grades and overall rater scores were the best indicators for first-year performance (multiple R=.66; 42.9% of the variance).Ce projet avait comme objectif, d’une part, d’étudier la fiabilité et la validité du processus d’admission à un programme du premier cycle de recherche en sciences de la santé et, d’autre part, d’évaluer les raisons évoquées par les étudiants pour s’inscrire au programme. Nous avons analysé les données d’admission (notes du secondaire, informations supplémentaires liées à la demande et la note globale de l’évaluateur) et la moyenne pondérée cumulative de la première année pour la première cohorte 2003-2004 (n=55, âge moyen 17,9 ans [écart type 1.0], 61,8% femmes et 38,2% hommes). Alors que l’objectif explicite du programme est d’instruire des étudiants qui deviendront chercheurs en santé, presque la moitié (43,6%) des étudiants ont déclaré qu’ils s’étaient inscrits au programme pour favoriser leurs chances d’être admis à une école de médecine. Les notes du secondaire et les notes globales des évaluateurs étaient les meilleurs indicateurs des performances en première année (multiple R=0,66; 42,9% de la variance)

Can an Evaluation of Students’ Stress Levels Help us Manage Anxiety During OSCEs and Other Assessment Modalities?

With an increased awareness of mental health issues, in both the student population and the veterinary profession in general, it is important that we obtain a greater understating of the stress experienced by students so as to better prepare them to deal with stress and ameliorate any negative effects it may have on performance. This study aims to characterise various measurements of stress (e.g. HRV, EEG, cortisol, self-report questionnaire) in students within the School of Veterinary Medicine in familiar test modalities, focussing on OSCE assessment. We would also investigate how performance is impacted and what potential factors may influence stress levels. Ultimately, our aim would be to evaluate intervention strategies to assess if students stress levels and performance can be improved

Reducing physician voiding cystourethrogram ordering in children with first febrile urinary tract infection: evaluation of a purposefully sequenced educational intervention

Background: Physicians often fail to implement clinical practice guidelines. Our aim was to evaluate whether a purposefully sequenced, multifaceted educational intervention would increase physician adherence to a guideline for voiding cystourethrogram (VCUG) use following first urinary tract infection (UTI) in young children.  Methods: Using a single centre, pretest-posttest design, we compared the proportion of guideline adherent VCUG orders and the VCUG ordering rate before and after three educational interventions (interactive lecture, clinical pathway, faxed reminder) selected and sequenced according to the PRECEDE (Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation) health promotion model.Results: One hundred and nine physicians ordered 219 VCUGs for 219 children. Following the interventions, there was an increase in the monthly proportion of adherent VCUGs ordered by pediatricians (analysis of variance (ANOVA) F(2,29) = 3.38, p = .048) and non-pediatricians (ANOVA F(2,28) = 14.71, p < .001). Also, pediatricians decreased their monthly VCUG ordering rate (linear trend incidence rate ratio 0.74, 95% confidence interval (CI) [0.54, 0.99]). Pediatricians were more likely to adhere with the guideline than were non-pediatricians (odds ratio 2.91, 95% CI [1.5, 5.5]).Conclusion: Exposure to purposefully sequenced educational interventions based on the PRECEDE model was associated with increased adherence to guideline recommendations.

Leadership competencies for medical education and healthcare professions: population-based study

Article deposited according to the BMJ Group policy for BMJ Open: http:// group.bmj.com/group/rights-licensing/permissions/authorreprints, August 21, 2012.YesFunding provided by the Open Access Authors Fund

Ego Identity Status of Medical Students in Clerkship

Background: Medical students encounter a variety of experiences that have an impact on their emerging professional identity. Clerkship, in particular, presents opportunities for students to consider their career options and decide upon a career path. The process of developing their professional identity begins well before clerkship, however. Anecdotal evidence suggests that interests in medicine begin as early as childhood. This study retrospectively examines the decision-making process clerks make in choosing medicine as a career.Methods: A total of 76 clerks (36 male, 34 female, 6 not reported) responded to four open-ended and two follow-up questions that measure career interests and pursuits. Questions addressed when and how students developed interests in medicine and alternate careers before beginning medical school. An additional eight closed questions drawn from the Ego Status Extended Objective Measure of Ego Identity Status II (EOM-EIS-II) were administered. Content analyses and inter-rater reliability analyses were conducted to classify students according to Marcia’s1  four ego identity statuses.Results: Having obtained high inter-rater consistency (Cohen’s Kappa coefficient of 0.92), responses to the open-ended questions resulted in the classification of three identity statuses. In total, 49.3% of students were in the ‘achieved’ (high exploration and commitment to choices) status and 48.1% were in the ‘foreclosed’ (low exploration but high commitment to choices) status. A small percentage (1.3%) of students were in the ‘moratorium’category (high exploration but low commitment to choices), while none of the students were in the ‘diffused’ (low exploration and low commitment to choices) category.Conclusions: With approximately half of the students demonstrating a ‘foreclosed’ status, this study reveals that despite exposure to a variety of careers when attending university, only half of the students had seriously pursued a career outside of medicine. The majority of students, moreover, developed an interest in medicine before adulthood, and did so independently from parental influence

Behavioral clusters and coronary heart disease risk

The purpose of the present study was to empirically identify individuals who differed in their patterns of components derived from the structured interview (SI), and to evaluate whether individuals characterized by the different patterns varied in terms of their risk for coronary heart disease (CHD). The present study represents a reanalysis of data from the Western Collaborative Group Study in which components of Type A were individually related to risk for CHD. Subgroups of individuals who differed in the patterns of their component scores were identified by means of cluster analytic techniques and were found to vary in their risk of CHD. As expected, a pattern of characteristics in which hostility was salient was found to be predictive of CHD. Moreover, another pattern of characteristics that appears to reflect pressured, controlling, socially dominant behavior in which hostility was not salient also was found to be predictive of CHD. Further, two patterns of characteristics were identified that were unrelated to CHD risk. Finally, two patterns of characteristics were identified that were related to reduced risk of CHD. Overall, these results suggest that future research should investigate variables in addition to hostility in regard to risk for and protection from CHD

The use of global rating scales for OSCEs in veterinary medicine

OSCEs (Objective Structured Clinical Examinations) are widely used in health professions to assess clinical skills competence. Raters use standardized binary checklists (CL) or multi-dimensional global rating scales (GRS) to score candidates performing specific tasks. This study assessed the reliability of CL and GRS scores in the assessment of veterinary students, and is the first study to demonstrate the reliability of GRS within veterinary medical education. Twelve raters from two different schools (6 from University of Calgary [UCVM] and 6 from Royal (Dick) School of Veterinary Studies [R(D)SVS] were asked to score 12 students (6 from each school). All raters assessed all students (video recordings) during 4 OSCE stations (bovine haltering, gowning and gloving, equine bandaging and skin suturing). Raters scored students using a CL, followed by the GRS. Novice raters (6 R(D)SVS) were assessed independently of expert raters (6 UCVM). Generalizability theory (G theory), analysis of variance (ANOVA) and t-tests were used to determine the reliability of rater scores, assess any between school differences (by student, by rater), and determine if there were differences between CL and GRS scores. There was no significant difference in rater performance with use of the CL or the GRS. Scores from the CL were significantly higher than scores from the GRS. The reliability of checklist scores were .42 and .76 for novice and expert raters respectively. The reliability of the global rating scale scores were .7 and .86 for novice and expert raters respectively. A decision study (D-study) showed that once trained using CL, GRS could be utilized to reliably score clinical skills in veterinary medicine with both novice and experienced raters

Global Methylation Patterns in Idiopathic Pulmonary Fibrosis

BACKGROUND: Idiopathic Pulmonary Fibrosis (IPF) is characterized by profound changes in the lung phenotype including excessive extracellular matrix deposition, myofibroblast foci, alveolar epithelial cell hyperplasia and extensive remodeling. The role of epigenetic changes in determining the lung phenotype in IPF is unknown. In this study we determine whether IPF lungs exhibit an altered global methylation profile.\ud \ud METHODOLOGY/PRINCIPAL FINDINGS: Immunoprecipitated methylated DNA from 12 IPF lungs, 10 lung adenocarcinomas and 10 normal histology lungs was hybridized to Agilent human CpG Islands Microarrays and data analysis was performed using BRB-Array Tools and DAVID Bioinformatics Resources software packages. Array results were validated using the EpiTYPER MassARRAY platform for 3 CpG islands. 625 CpG islands were differentially methylated between IPF and control lungs with an estimated False Discovery Rate less than 5%. The genes associated with the differentially methylated CpG islands are involved in regulation of apoptosis, morphogenesis and cellular biosynthetic processes. The expression of three genes (STK17B, STK3 and HIST1H2AH) with hypomethylated promoters was increased in IPF lungs. Comparison of IPF methylation patterns to lung cancer or control samples, revealed that IPF lungs display an intermediate methylation profile, partly similar to lung cancer and partly similar to control with 402 differentially methylated CpG islands overlapping between IPF and cancer. Despite their similarity to cancer, IPF lungs did not exhibit hypomethylation of long interspersed nuclear element 1 (LINE-1) retrotransposon while lung cancer samples did, suggesting that the global hypomethylation observed in cancer was not typical of IPF.\ud \ud CONCLUSIONS/SIGNIFICANCE: Our results provide evidence that epigenetic changes in IPF are widespread and potentially important. The partial similarity to cancer may signify similar pathogenetic mechanisms while the differences constitute IPF or cancer specific changes. Elucidating the role of these specific changes will potentially allow better understanding of the pathogenesis of IPF.\ud \u

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries