Dilemmas and solutions- experiences of a national Family Medicine applied knowledge licensing test during a pandemic

ABSTRACT: Background: The unprecedented COVID-19 pandemic brought significant challenges to all of medicine, including primary care training and examinations. The MRCGP AKT is high-stakes licensing 200-item MCQ for UK trainee family physicians and is part of an assessment tripos that, up to the onset of the pandemic, included a Clinical Skills Assessment using Simulated Patients and workplace based assessment. The AKT is blueprinted onto a curriculum content specification and computer delivered three times a year at test centres across the UK. It tests the knowledge base underpinning independent general practice within the context of the UK National Health Service. We report on the challenges and dilemmas faced during the pandemic, decisions taken, and lessons learned. Rapid exam changes needed to be made, and communicated effectively to candidates, whilst maintaining standards and fairness to candidates. Summary of Work: Challenges included lockdown travel restrictions, reduced capacity, social distancing and shielding candidates being unable to leave home. The April 2020 AKT was cancelled and prioritisation measures implemented to ensure candidates at the end of their training could enter the (stressed) workforce. We engaged with a wide range of stakeholders, carefully looked at remote testing, made contingency plans prioritised for those unable to sit exams and changed exam regulations to ensure fairness to candidates. In this emergency, we delivered a previously published exam which some candidates were unaware they had sat previously, and assessed how these candidates performed. We compared cohort performance before and during the pandemic. Summary of Results: We summarise why we did not remote test, how we obtained key worker status, and adapted contingency plans. Analysis of candidates who had previously sat the same exam showed they performed less well. Despite wide-ranging changes in training and workplace experience, there was no significant difference in cohort performance overall pre-and peri-pandemic. Discussion and Conclusions: COVID-19 constraints changed trainees clinical exposure, restricted training and supervisor support. However, exam preparedness did not appear adversely affected when measured by overall pass rates. Unexpectedly, candidates who sat an identical exam did not benefit from previous exposure. Take-home Messages: Involving stakeholders in key decisions and regular communications are essential. Test security and standards were not compromised

A note on a matrix criterion for unique colorability of a signed graph

A signed graph, S , is colorable if its point set can be partitioned into subsets such that all positive lines join points of the same subset and all negative lines join points of different subsets. S is uniquely colorable if there is only one such partition. Developed in this note is a new matrix, called the type matrix of S , which provides a classification of the way pairs of points are joined in S . Such a classification yields a criterion for colorability and unique colorability.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45725/1/11336_2005_Article_BF02289592.pd

Allergic conditions and risk of hematological malignancies in adults: a cohort study

BACKGROUND: Two contradictory hypotheses have been proposed to explain the relationship between allergic conditions and malignancies, the immune surveillance hypothesis and the antigenic stimulation hypothesis. The former advocates that allergic conditions may be protective against development of cancer, whereas the latter proposes an increased risk. This relationship has been studied in several case-control studies, but only in a few cohort studies. METHODS: The association between allergic conditions and risk of developing leukemia, Hodgkin's disease, non-Hodgkin's lymphoma and myeloma was investigated in a cohort of 16,539 Swedish twins born 1886–1925. Prospectively collected, self-reported information about allergic conditions such as asthma, hay fever or eczema was obtained through questionnaires administered in 1967. The cohort was followed 1969–99 and cancer incidence was ascertained from the Swedish Cancer Registry. RESULTS: Hives and asthma tended to increase the risk of leukemia (relative risk [RR] = 2.1, 95% Confidence Interval [CI] 1.0–4.5 and RR = 1.6, 95% CI 0.8–3.5, respectively). There was also an indication of an increased risk of non-Hodgkin's lymphoma associated with eczema during childhood (RR = 2.3, 95% CI 1.0–5.3). CONCLUSION: In contrast to most previous studies, our results do not indicate a protective effect of allergic conditions on the risk of developing hematological malignancies. Rather, they suggest that allergic conditions might increase the risk of some hematological malignancies

The moderating role of transformational leadership on HR practices in M&A integration

Scant research exists examining the effect of HRM practices on employee behavior in M&A integration and the role that leaders play within this. This paper develops a conceptual framework that focuses on the moderating role of transformational leadership on the achievement of human integration and organizational identification in M&A integration. We argue that communication, employee involvement, teamwork, and training and development have a positive effect on employee behavior and their identification with the newly formed organization. Moreover, we argue that transformational leadership behaviors will moderate the implementation of HRM practices in M&As, leading to positive employee behavior and employee identification in the new organization. We suggest that further research is necessary to test propositions of the present study in order to achieve finer-grained understanding of the role of transformational leadership on the achievement of human integration and organizational identification in M&A integration

The impact of leadership and change management strategy on organizational culture and individual acceptance of change during a merger

This article reports a longitudinal study that examined mergers between three large multi-site public-sector organizations. Both qualitative and quantitative methods of analysis are used to examine the effect of leadership and change management strategies on acceptance of cultural change by individuals. Findings indicate that in many cases the change that occurs as a result of a merger is imposed on the leaders themselves, and it is often the pace of change that inhibits the successful re-engineering of the culture. In this respect, the success or otherwise of any merger hinges on individual perceptions about the manner in which the process is handled and the direction in which the culture is moved. Communication and a transparent change process are important, as this will often determine not only how a leader will be regarded, but who will be regarded as a leader. Leaders need to be competent and trained in the process of transforming organizations to ensure that individuals within the organization accept the changes prompted by a merger

Social identity change during and intergroup merger: the role of status, similarity, and identity threat

Conducted during the merger between two hospitals, this longitudinal study (N = 149) revealed that at both Time 1 (i.e., questionnaire completed 12 months prior to the merger) and Time 2 (completed 1 year after the merger had been implemented), employees from the low-status premerger organization generally reported lower adjustment to the merger. Whereas Time 2 identity threat predicted lower and decreased identification with the new merged organization and perceptions of a common in group identity, perceived similarities between the merging organizations at Time 2 predicted higher identification with the new merged organization and higher perceptions of a common in group identity