Pre/post-testing in evaluation of students’ gain of content knowledge from a blood and lymph course

Background: There is an increased interest in programme evaluation, especially the definition of goals and the measurement of educational outcomes.Objective: To evaluate the student gain of content knowledge in one of phase II modules (blood and lymph) as an institutional self evaluation process.Method: This descriptive study assessed the students’ gain of content knowledge of the blood and lymph course via pre- and post-testing. A sample of 214 second-year pre-clinical medical students comprising 114 males and 110 females of the Faculty of Medicine and Health Sciences, Omdurman Islamic University, Omdurman, Sudan participated in the study. Data were analysed using SPPS, version 15. The t-test (unpaired) was used for the difference of means. Pearson’s correlation coefficient was used and P < 0.05 was considered as statistically significant.Results: The mean post-test score (7.99/12, SD = 2.17) was significantly higher (P < 0.0001) than the mean pre-test score (4.64/12, SD = 1.69). The average normalized gain (gain score) is 0.83. There is no statistically significant difference in the pre- and post-test scores between male andfemale students (P-values: 0.838 and 0.328).Conclusion: The curriculum content of the blood and lymph course is effective in increasing students’ knowledge about the haemopoietic system. Gender difference of students or instructors does not affect students’ gain. We believe that other institutions should consider the use of pre- and post-tests as a useful direct method of programme evaluation.Key words: Educational outcomes, the average normalized gain, hybrid curriculum

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

Background Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. Methods We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). Findings In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683–0·717]). Interpretation In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. Funding British Journal of Surgery Society