How well do selection tools predict performance later in a medical programme?

The choice of tools with which to select medical students is complex and controversial. This study aimed to identify the extent to which scores on each of three admission tools (Admission GPA, UMAT and structured interview) predicted the outcomes of the first major clinical year (Y4) of a 6 year medical programme. Data from three student cohorts (n = 324) were analysed using regression analyses. The Admission GPA was the best predictor of academic achievement in years 2 and 3 with regression coefficients (B) of 1.31 and 0.9 respectively (each P < 0.001). Furthermore, Admission GPA predicted whether or not a student was likely to earn 'Distinction' rather than 'Pass' in year 4. In comparison, UMAT and interview showed low predictive ability for any outcomes. Interview scores correlated negatively with those on the other tools. None of the tools predicted failure to complete year 4 on time, but only 3% of students fell into this category. Prior academic achievement remains the best measure of subsequent student achievement within a medical programme. Interview scores have little predictive value. Future directions include longer term studies of what UMAT predicts, and of novel ways to combine selection tools to achieve the optimum student cohort

Short-acting beta2-agonists for stable chronic obstructive pulmonary disease

Background: Chronic Obstructive Pulmonary Disease (COPD) is a chronic condition characterised by progressive airflow limitation that is at most partially reversible. Despite the lack of reversibility patients often report symptomatic improvement with short-acting beta-2 bronchodilator medication. Short-acting beta-2 bronchodilators are used in the management of both stable and acute exacerbations of COPD. Objectives: To determine the clinical effectiveness and assess the adverse effects of regular treatmentwith short-acting beta-2 agonists bronchodilators in patients with stable COPD. Search strategy: A search was carried out using the Cochrane Airways Group database. In addition, the reference lists of review articles and the randomised controlled trials (RCTs) retrieved in full text were searched for other potentially relevant citations. Selection criteria: RCTs of at least one week in duration comparing treatment with inhaled short-acting beta-2 agonists with placebo in patients with stable COPD. Data collection and analysis Data extraction and study quality assessment was performed independently by two reviewers. Where further or missing data was required, authors of studies were contacted. The data were analysed using the Cochrane Review Manager software. Main results: Thirteen studies were included in this review. All studies used a crossover design and were of high quality. Spirometry performed at the end of the study period and after the administration of treatment (post-bronchodilator) showed a slight but significant increase in FEV1 and FVC when compared to placebo (WMD 0.14 L; 95%CI 0.04, 0.25 & WMD 0.30 L; 95%CI 0.02, 0.58, respectively). In addition, both morning and evening PEFR were significantly better during active treatment than during placebo (WMD 29.17 L/min; 95%CI 0.25, 58.09 & WMD 36.75 L/min; 95%CI 2.56, 70.94, respectively). A significant improvement in daily breathlessness score was observed during treatment with beta-2 agonist when compared to placebo (SMD 1.33; 95%CI 1.0, 1.65). The risk of dropping out of the study (treatment failure) when on treatment with placebo was almost twice that of patients on treatment with beta-2 agonists (RR 0.49; 95%CI 0.33, 0.73). Patients preferred beta-2 agonists almost 10 times more frequently to placebo (OR 9.04; 95%CI 4.64, 17.61). One study that used a validated questionnaire for 'quality of life' assessment, found highly significant improvements in the scores for dyspnoea (p=0.003) and fatigue (p=0.0003) during treatment with salbutamol. No studies reported serious side effects during treatment with inhaled beta-agonists. However, none of the studies were of sufficient length or size in order to allow any meaningful information on long-term occurrence of side effects. Authors' conclusions: Use of short-acting beta-2 agonists on a regular basis for at least seven days in stable COPD is associated with improvements in post bronchodilator lung function and a decrease in breathlessness. Patients are far more likely to prefer treatment with beta-2 agonists than placebo, and less likely to drop out from such treatment. None of the studies included in this review reported sufficient data or were of sufficient length or size in order to provide reliable information on adverse effects. Therefore large scale, parallel, longer term studies would be needed to investigate the effect of treatment with regular inhaled beta-2 agonists on mortality, disease progression and side effects. Newer, long acting bronchodilators (including long-acting beta-2 agonists) are currently available and they may be more practical and/or effective in these patients. However, this review indicates that treatment with these older, inexpensive drugs is beneficial in patients with COPD. Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd

Medical education to improve Māori health

Medical education in Aotearoa/New Zealand has a critical role to play in producing a health professional workforce that is prepared to meet the challenge of addressing Māori health. While cultural competence is an important aspect of this, we argue that Māori health is an educational domain in its own right with distinct learning objectives and educational approaches. An emerging consensus as to the optimal graduate outcomes and key components of a Māori health curriculum is supported by a growing international evidence base in indigenous health education. Several significant challenges exist, many of which can be overcome by reorienting institutional systems, structures and processes to support effective Māori health teaching and learning. We recommend a combination of immersed, integrated and independent teaching and learning approaches in order to promote high-quality outcomes

Medical education to improve Māori health

Medical education in Aotearoa/New Zealand has a critical role to play in producing a health professional workforce that is prepared to meet the challenge of addressing Māori health. While cultural competence is an important aspect of this, we argue that Māori health is an educational domain in its own right with distinct learning objectives and educational approaches. An emerging consensus as to the optimal graduate outcomes and key components of a Māori health curriculum is supported by a growing international evidence base in indigenous health education. Several significant challenges exist, many of which can be overcome by reorienting institutional systems, structures and processes to support effective Māori health teaching and learning. We recommend a combination of immersed, integrated and independent teaching and learning approaches in order to promote high-quality outcomes

Sample representativeness and influence of attrition on longitudinal data collected as part of a national medical career tracking project

Abstract Background The Medical Schools Outcomes Database and Longitudinal Tracking Project (MSOD) in New Zealand is one example of a national survey-based resource of medical student experiences and career outcomes. Longitudinal studies of medical students are valuable for evaluating the outcomes of medical programs against workforce objectives. As a prospective longitudinal multiple-cohort study, survey response rates at each collection point of MSOD vary. This paper assesses the effects of participant non-response rates on MSOD data. Methods Demographic variables of MSOD respondents between 2012 and 2018 were compared to the distribution of the demographic variables in the population of all NZ medical graduates to ascertain whether respondent samples at multiple survey collection points were representative of the population. Analysis using logistic regression assessed the impact of participant non-response on variables at collection points throughout MSOD. Results 2874 out of a total population of 2939 domestic medical students graduating between 2012 and 2018 responded to MSOD surveys. Entry and exit surveys achieved response rates around 80% and were broadly representative of the total population on demographic variables. Post-graduation survey response rates were around 50% of the total population of graduates and underrepresented graduates from the University of Auckland. Between the entry and exit and the exit and postgraduation year three samples, there was a significant impact of non-response on ascribed variables, including age at graduation, university, gender and ethnic identity. Between the exit and postgraduation year one sample, non-response significantly impacted ascribed and non-ascribed variables, including future practice intentions. Conclusion Samples collected from MSOD at entry and exit are representative, and findings from cross-sectional studies using these datasets are likely generalisable to the wider population of NZ medical graduates. Samples collected one and three years post-graduation are less representative. Researchers should be aware of this bias when utilizing these data. When using MSOD data in a longitudinal manner, e.g. comparing the change in career intentions from one collection point to the next, researchers should appropriately control for bias due to non-response between collection points. This study highlights the value of longitudinal career-tracking studies for answering questions relevant to medical education and workforce development