Which Model is the Best Predictor of Learning Achievement: Raw Score, Relative Growth or Knowledge Retention Score.

Objective: To verify the student learning performance using the raw score, relative growth score and knowledge retention score. Methods: Thirty-two nurse anesthetist students in academic years 2011-12, Faculty of Medicine, Siriraj Hospital, Mahidol University, volunteered to participate. After pretest, they studied the designated subject via a website. After 3 weeks, the system was locked and students underwent the post-test. The final1 and final2 test were held in a classroom without prior notice. The post and final1 test as well as the final1 and final2 test took place exactly 4 weeks apart. The difference scores between pre and post-test, pre and final1 test, as well as pre and final2 test were calculated for relative growth score G1, G2 and G3 respectively. Thus the differences between G1 and G2 as well as G1 and G3 were determined as knowledge retention score R1 and R2 respectively. Results: The post, final1 and final2 test scores were significantly higher than the pretest one significantly. However, the post, final1 and final2 test scores showed no statistical difference. Though G2 and G3 appeared to decrease as compared to G1, they were not significant. The R2 showed higher than R1 without significant difference; however, they showed a strong correlation to each other (r = .69) Conclusion: The knowledge retention score was the best prediction on academic gains.

A comparison of knowledge retention between online and in-class problem-based learning.

Objective: To compare knowledge retention of the two learning methods: online (OPBL) and in-class problem-based learning (IPBL). Methods: A pre and post-test study design of the three-week research project was performed in volunteered students from two-academic year. After completing the pretest, the IPBL group performed an activity test. Then the instructor held an open discussion for further explanation and clarification. Afterwards, students performed a diagnostic test to earn their achievement score. The 3-hour activities in each learning specification part took place exactly a week apart. The contrary, the OPBL group performed all tests by log on the website. The online program not only established their weaknesses and urged them to explore core knowledge, but also recorded students’ profiles. After three weeks, the post-test was arranged for both groups. Four week later, the final test was managed without prior notice. The pretest, post-test and final test forms were parallel under the same table of specifications. Results: The pretest, post-test and final test scores of the IPBL group and the OPBL group were 4.57 ± 2.92, 23.74 ± 7.58, and 12.70 ± 5.19; 4.94 ± 6.31, 31.67 ± 7.07, and 25.77 ± 5.9 respectively. The growths of knowledge after the post-test and after the final test as well as the retention of knowledge of the IPBL group and the OPBL group were 54.32%, 22.64%, and 68.32%; 76.01%, 59.63%, and 83.64% respectively. Conclusion: The OPBL yielded the better knowledge retention. The key success factors might depend on students’ achievement motive and a sense of self-actualization.

Developing a Two-Tier Diagnostic Test to assess Arterial Blood Gases learning by students with different background knowledge in Anesthesiology.

Objectives: To develop a two-tier diagnostic test in medical education on the analysis of arterial blood gases (ABGs) by students with different background knowledge in anesthesiology, using a concept and knowledge map to determine table of specifications together with an open discussion and a feedback-providing method. Methods: A research and development study in which the developed diagnostic test was assessed for its efficiency by first-year residents, preclinical medical students and nurse anesthetist students who volunteered to join the project. Results: There were four major misconceptions in ABGs: First, they could not clarify the significance and relationship of the symbols. Second, they could not remember the formulas and use them appropriately. Third, they did not understand the analytical steps and lacked knowledge for clinical interpretation. Fourth, they could not apply the logical results as a guideline for patient management. Medical and nurse anesthetist students had problems mainly on the third/fourth misconceptions and partly on the first/second misconceptions. Nevertheless, residents had problems mainly on the fourth misconception and partly on the third misconception. The assessment of criterion-referenced test item difficulty, discrimination and reliability (internal consistency) was 0.59, 0.38 and 0.91 respectively. The item objective congruency (IOC) of the test was equal to 0.88. Conclusions: Using a concept and knowledge map to define the table of specifications in ABGs concepts together with an open discussion and feedback-providing method helped facilitate the scope of developing a two-tier diagnostic more practical test. Teachers can assess misconceptions of students with different background knowledge in a short period of time and have guidelines to improve pedagogy in response to their eagerness for learning.

Carotid body tumor resection and hypotensive anaesthesia during 1985-1991.

We retrospectively analysed the administration of anaesthesia for carotid body tumor resection in Siriraj Hospital during 1985-1991. The tumors were excised from seven patients under general hypotensive anaesthesia. Such slow-growing large tumors frequently encircle the internal and external carotid arteries, which increases the risk of massive blood loss and damage to major cranial nerves. Thus, carotid arteriography for diagnosis and demonstration of collateral circulation and cardiovascular monitoring during resection was indispensable. All tumors were completive death. Following surgery, one patient developed transient weakness of the upper extremity which lasted one week. Cranial nerve palsy (CN IX, X) occurred in one patient who recovered in three months.

Preoperative autologous blood collection and haemodilution with dextran.

Thirty patients, ASA class I-II with haemoglobin level > 12.5 gm percent, who underwent elective gynaecological surgery were included in the study. Control blood samples for haematocrit, haemoglobin, electrolytes, serum osmolarity, coagulogram and platelet function were investigated before the autologous blood was collected and haemodiluted with 3 percent dextran-40 solution. The cardiovascular responses, arterial blood gases, urine output and central venous pressure were also recorded. After the end of haemodilution, another blood samples (as study samples) were once collected for analysis. Haematocrit, haemoglobin, sodium and potassium showed to decrease significantly. However, the serum osmolarrity, coagulogram and platelet function had no any significant differences. All parameters were within normal limits. In conclusion, the autologous blood collection and haemodilution technique was suitable and possibly practical in ever elective surgical patients without any undesirable side effects.