Validation and clinical application of the Metacognitions Questionnaire in a sample of Brazilian generalized anxiety disorder patients: the effects of different treatment interventions

Abstract Introduction Metacognitive beliefs about worry may trigger anxiety. However, the effect of generalized anxiety disorder (GAD) treatment on metacognition has not yet been investigated. Objectives To validate the Metacognitions Questionnaire (MCQ-30) in a Brazilian GAD sample and verify whether different interventions reduce metacognitive beliefs. Method We recruited 180 GAD individuals and randomized them to Body in Mind Training (BMT), Fluoxetine (FLX), or an active control group (Quality of Life [QoL]) for 8 weeks. The MCQ-30 was assessed for internal consistency, was evaluated with confirmatory and exploratory factor analyses, and was tested for convergent validity with the Penn State Worry Questionnaire (PSWQ). Generalized estimating equations (GEE) were employed to analyze differences after the interventions. Results The MCQ-30 demonstrated good internal consistency and acceptability; the original five-factor model was supported. There was a positive moderate correlation between MCQ-30 scores and worry. GEE showed a significant group x time interaction (p < 0.001). Both BMT (mean difference [MD] = -6.04, standard error [SE] = -2.39, p = 0.034) and FLX (MD = -5.78, SE = 1.91, p = 0.007) reduced MCQ-30 scores. FLX was superior to QoL, but not BMT, at weeks 5 and 8. There were no differences between BMT and QoL. Conclusion The Brazilian-Portuguese version of MCQ-30 showed good psychometric properties. Furthermore, the positive effect of FLX and BMT on metacognition suggests it may represent a potential therapeutic target.

Introduction of SDL in Department of Anatomy: Evaluation of Learning and SDL Readiness

Background: Self-directed learning (SDL) is a process in which individuals assume the responsibility of identifying their learning needs, setting goals, locating sources, developing and implementing proper strategies, and evaluating the outcomes of learning both individually and collectively. The advantages of SDL include, but not limited to, gaining more autonomy in learning, having higher motivation for it, acquiring lifelong learning skills, and developing greater self-control, self-confidence, and self-management. SDL has become popular in medical curricula and has been advocated as an effective learning strategy for medical students to develop competence in knowledge acquisition. Aim and Objectives: To introduce self directed learning in the Department of Anatomy, to encourage faculty members to accept SDL as a Teaching Learning method and encouraging students to develop an attitude of self directed learning & to become lifelong learners. Methodology: After proper sensitization of the faculty & students regarding SDL, two sessions were conducted during the Anatomy Dissection Hall timings of the First Year students. The performance of the students, in the SDL topics was assessed using the MCQ & SAQ tests. Feedback regarding the SDL methodology was taken both from the students as well as the faculty. Also the Questionnaires were given to students applying Fischer’s Self Directed Learning Readiness Scale (SDLRS) & Jefferson Scale of Life Long learning –Health Profession Version (JeffSLL-HSP) & the results were statistically analyzed. Results: A total of 126 MBBS students of the first semester participated in SDL session and most students scored more than mean score in the tests after SDL sessions, there was a fourfold increase in the number of students scoring more than 80% in the two SDL tests. Also participating students showed high readiness towards SDL and were oriented to become Life Long Learners. Conclusions: SDL can be effectively implemented in the Department of Anatomy and it motivates students to become life long learners.

Role of Multiple Choice Questions in Assessment of Competency of Knowledge in Anatomy

Objectives: The main objective of the current study is to examine the items using the item analysis to assess their competency of knowledge in human anatomy. Methods: This is a quantitative descriptive cross-sectional study conducted at the Najran University faculty of Medicine, in the department of anatomy. A 31-second year MBBS students of level three took the multiple-choice question exam comprising 100 questions in one session. Each item was analyzed by item analysis. The planned period of data collection is the first semester of the academic year 2019-2020. The data were analyzed using SPSS version 25, and Excel Software. All analyses were performed using the descriptive frequency, explore and correlation probabilities a p-value, p<0.01 (2-sided) was considered to indicate statistical significance. Results: The assessment of test items use the item analysis that is very difficult question: 25; 25%, difficult question: 8; 8%, average question: 46; 46%, easy questions; 9; 9% and very easy: 9; 9%. The discrimination indices, which are poor discrimination; 34; 34%, acceptable discrimination; 11; 11%,good discrimination; 6; 6%, very good discrimination; 4; 4% and excellent discrimination; 45; 45%. The performance of students in this test showing that a large number of items have a role in distinguishing students knowledge in the anatomy test, but in Simple parts of the scale that the items did not succeed in assessing students. Items of anatomy exams displayed a strong relationship of difficulty (P) and discrimination (D) indices. Conclusion: The MCQs items assess their competency of knowledge in human anatomy. The competence of students in the knowledge of anatomy measured at a high rate of A-type context-rich MCQs can be stem is case scenario, lead-in; question and options; distractors, and key. These items can differentiate good and poor accomplishment students..

Lessons Learned From Performance Of Students Of Pharmacology In Self Coded Surprise Test With Negative Marking

Introduction: The present study aims to find the effect of instruction of negative marking in a self-coded MCQ examination on the performance of students in the subject of Pharmacology concerning the raw score, correct score and negative score. Methodology: This longitudinal study was conducted in the Department of Pharmacology. The Second MBBS students were exposed to a self-coded MCQ test twice by surprise. The first test (T1) was given without instructions of negative marking, while during the second test (T2) instructions for negative marking were given. The parameters of the raw score, negative score, corrected score and number of students who did not attempt respective MCQs was calculated. The number of students passing with modified Minimum Passing Level was calculated was compared with conventional Minimum Passing Level. Results:Sixty-seven students participated in the study. There was a statistically significant decrease in the raw score in the T2, while an increase in the negative score when compared with T1. The number of non-attempted questions was increased in T2. There was a statistically significant difference in the number of students passed concerning raw score in T1 and T2, while no such difference was seen concerning Negative score and Corrected score. Conclusion:The Corrected score and Negative score are not affected by the minimum passing level, indicating a better parameter of scoring than the raw score. Hence, the use of Negative score or Corrected score should be encouraged rather than the use of conventional Raw score.

Modified tutorials in Pharmacology for Medical students using case based learning and multiple choice questions

Background: Active student centred learning is the need of the hour. Objectives being to compare the difference in the post test scores between students exposed to Case based learning (CBL) and Multiple choice questions (MCQ) (learning tool) during tutorials in Pharmacology for 2nd MBBS students. To understand the perception of students regarding teaching learning tools used in the study.Methods: This was a mixed methods study. Sixty eight students were divided into 2 groups. Hypertension and angina was discussed as CBL for Group 1 and as MCQ (Learning tool) for Group 2. One week later, cross over was done, Thyroid and Diabetes was discussed as MCQ for Group 1 and as CBL for Group 2. Post-test MCQ, pre validated questions (Likert scale) and open ended questions (qualitative) were distributed. Statistical Analysis: Difference in the post test scores in both the groups was analyzed using independent sample t test.Results: There was no significant difference in post test scores between CBL and MCQ groups. Questionnaire analysis suggested that both the methods provoked self-learning (45%). Thematic analysis demonstrated the positive experiences like motivated self-learning, clinical application, better understanding than theory classes and drawbacks being time consuming and fear of presentation.Conclusions: Since the study included both qualitative and quantitative analysis, the results can be elucidated comprehensively. This study implies that CBL and MCQ are effective and can be implemented into the curriculum of Pharmacology. This study can serve as an evidence to incorporate these tools in the curriculum.

Childbirth satisfaction and maternal role confidence of early postpartum mothers from maternity units

@#<p style="text-align: justify;">Promoting positive birth experiences may help create circumstances amenable to enhancing the quality of obstetric care and improving outcomes for mothers and infants. This study aims to examine the relationship between childbirth satisfaction and maternal confidence during early postpartum period in mothers from maternity units of San Jose, Occidental Mindoro. This is a descriptive cross-sectional study utilizing Women's Views of Birth Labour Satisfaction Questionnaire (WOMBLSQ) and Maternal Confidence Questionnaire (MCQ). To correlate the level of childbirth satisfaction and maternal role confidence of early postpartum mothers, Pearson's R correlation was used. A p value of 0.05 was taken for statistical significance. It revealed that the early postpartum mother respondents in the study were satisfied with their childbirth experience and confident with their maternal role. Moreover, the childbirth satisfaction was positively correlated with maternal role confidence. It is implicated in the practice of healthcare professionals to provide better understanding of the factors that influence maternal role within their particular social contexts.</p>

Item Analysis, Reliability Statistics And Standard Error Of Measurement To Improve The Quality And Impact Of Multiple Choice Questions In Undergraduate Medical Education In Faculty Of Medicine At Unisza

Multiple-choice question as one best answer (OBA) is considered as a more effective tool to test higher order thinking for its reliability and validity compared to objective test (multiple true and false) items. However, to determine quality of OBA questions it needs item analysis for difficulty index (PI) and discrimination index (DI) as well as distractor efficiency (DE) with functional distractor (FD) and non-functional distractor (NFD). However, any flaw in item structuring should not be allowed to affect students’ performance due to the error of measurement. Standard error of measurement (SEM) to calculate a band of score can be utilized to reduce the impact of error in assessment. Present study evaluates the quality of 30 items OBA administered in professional II examination to apply the corrective measures and produce quality items for the question bank. The mean (SD) of 30 items OBA = 61.11 (7.495) and the reliability (internal consistency) as Cronbach’s alpha = 0.447. Out of 30 OBA items 11(36.66%) with PI = 0.31-0.60 and 12 items (40.00%) with DI = ≥0.19 were placed in category to retain item in question bank, 6 items (20.00%) in category to revise items with DI ≤0.19 and remaining 12 items (40.00%) in category to discard items for either with a poor or with negative DI. Out of a total 120 distractors, the non-functional distractors (NFD) were 63 (52.5%) and functional distracters were 57 (47.5%). 28 items (93.33%) were found to contain 1- 4 NFD and only 2 (6.66%) items were without any NFD. Distracter efficiency (DE) result of 28 items with NDF and only 2 items without NDF showed 7 items each with 1 NFD (75% DE) and 4 NFD (0% DE), 10 items with 2 NFD (50% DE) and 4 items with 3 NFD (25% DE). Standard error of measurement (SEM) calculated for OBA has been ± 5.51 and considering the borderline cut-off point set at ≥45%, a band score within 1 SD (68%) is generated for OBA. The high frequency of difficult or easy items and moderate to poor discrimination suggest the need of items corrective measure. Increased number of NFD and low DE in this study indicates difficulty of teaching faculty in developing plausible distractors for OBA question. Standard error of measurement (SEM) should be utilized to calculate a band of score to make logical decision on pass or fail of borderline students.

MCQ Supplementation in a Physiology Didactic Class: A Learning Tool.

Background and Objectives: Medical educators are facing the challenge to develop innovative creative material so as to engage the students in active learning, more so for basic sciences. In addition the innovations should help student learning, keeping time and manpower and economy constraints in mind. Overall objective of this study was to study and assess the role of MCQ supplementation in a didactic class in improving student learning. Methods: 136 First year MBBS students of a government medical college attending physiology classes were recruited for the study. Based on the university recognized syllabus the Specific learning objectives (SLOs) were randomly grouped into two categories, that is, SLOs for which didactic classes were to be supplemented with multiple choice questions (MCQs) and those SLOs for which didactic classes were to be taught without MCQ supplementation. Results: On subjecting individual student’s scores obtained in the two categories of MCQs to unpaired ‘t’ test the difference was found to be statistically significant, p = 0.025, t = 2.259. 95% CI. Conclusion: Reinforcement of Didactic class with MCQ supplementation is an effective learning tool which was well received by the participants.

Comparison of Pharmacist License Examination between Korea and Canada

A newly-structured Korean pharmacist license exam has been launched in 2015, reflecting upon the changes in the pharmacy curriculum from a 4 year program to a 6 year program in 2009. In order to provide new ideas to ensure that the new exam is one of the most effective pharmacist evaluations that have taken place thus far, this study was done to compare the pharmacy exams in Korea and Canada. One of the major differences noted between the two countries' exams is that along with paper based MCQ portion of the exam, Canada's exam also includes a performance-based section, known as OSCE, which the Korean Pharmacy Exam (KPE) does not have. Furthermore, with the MCQ portion of the exam, the Canadian exam asks about 300 questions, with 450 minutes of test time allocated and taken during a period of two consecutive days, the KPE asks 350 questions, with 325 minutes of test time allocated in one day. Although, similarly, many of the questions in both exams place emphasis on clinical or patient care, Canada's exam puts significantly more emphasis (50.5% of exam questions) on these types of questions than Korea (29.7% of exam questions). However, this percentage does not reflect the exact weight placed for the specific areas of knowledge it requires to answer these questions, since the types of questions asked in this section in Canada could be placed in another section on the KPE. Canada's exam also has more questions (10% +150 questions for BC) on the topics of law and ethics compared to the KPE (5.7%). The reason for this may be that the Canadian society puts emphasis on the legal and ethical duties of pharmacists as a leader. However, since each country is unique in their social, economical, and cultural points of view, comparing the KPE to the Canadian licensing exam and applying these differences to the new KPE may not be appropriate. One last thing to consider is that, as WHO/FIP mentioned, in good pharmacy practice, continually updating and developing an appropriate pharmacy exam with consideration of societal changes, is key to success in developing the scope of practice for current and future pharmacists.

Validação psicométrica do Marijuana Craving Questionnaire-Short Form – versão Brasil / Psychometric validation of Marijuana Craving Questionnaire-Short Form – Brazil version

Introdução: O objetivo deste estudo foi realizar a validação psicométrica do Marijuana Craving Questionnaire-Short Form - Versão Brasil (MCQ-SF – Versão Brasil). Métodos: Neste estudo transversal, uma amostra não aleatória de 120 participantes do sexo masculino foi dividida em dois grupos: Grupo 1, incluindo usuários de cannabis da população geral (n=34) e Grupo 2, incluindo pacientes internados em unidade de dependência química e que preenchiam critérios diagnósticos para dependência de cannabis pela CID-10 (n=86). Os indivíduos do Grupo 1, que foram recrutados pelo método snow-ball, deviam estar utilizando a cannabis há pelo menos um ano, tê-la utilizado pela última vez há no mínimo 24 e no máximo 48 horas, e não ser dependentes de outras substâncias psicoativas salvo a nicotina. Os indivíduos do Grupo 2 deviam apenas preencher critérios diagnósticos para dependência de cannabis, não sendo necessário que não fossem dependentes de outras substâncias psicoativas. Além disso, deviam estar utilizando a cannabis há pelo menos um ano e tê-la utilizado pela última vez há no mínimo 24 horas. Os instrumentos utilizados foram: entrevista clínica com dados sociodemográficos, SRQ20, MMSE, MCQ-SF – Versão Brasil, EAV do craving, BDI, BAI, estímulo visual indutor de craving. Resultados: Na análise fatorial, foram encontrados três fatores: Emocionalidade, Intencionalidade e Compulsividade. Os três fatores apresentaram variância total de 66,74%. O alfa de Cronbach do seu total de pontos foi 0,89. O instrumento no total de pontos foi correlacionado com a Escala Analógico-Visual (r=0,644; p<0,01) Conclusões: Conclui-se que o MCQ-SF – Versão Brasil demonstrou ter propriedades psicométricas satisfatórias.

Introduction: We aimed to conduct a psychometric validation of the Marijuana Craving Questionnaire-Short Form – Brazil Version (MCQ-SF – Brazil Version). Methods: In this cross-sectional study, a non-random sample of 120 males were allocated into two groups: Group 1, including cannabis users in the general population (n=34) or Group 2, including patients admitted to a chemical dependency unit and who met diagnostic criteria for cannabis dependence in the ICD-10 (n=86). The subjects in Group 1, who were recruited by the snowball method, should be using cannabis for at least 1 year and for the last time between 24 and 48 hours before data collection. Additionally, they should not have any other addiction except nicotine. Subjects in Group 2 should only fulfill diagnostic criteria for cannabis dependence and may also be dependent on other psychoactive substances. The subjects should be using cannabis for at least one year and for the last time at least 24 hours before data collection. The instruments used were: clinical interview with sociodemographic data, SRQ20, MMSE, MCQ-SF Brazil Version - VAS of Craving, BDI, BAI, and visual stimulus inducing craving. Results: Factor analysis revealed three factors: Emotionality, Intentionality and Compulsivity. The three factors showed a total variance of 66.74%. Cronbach’s alpha of the total score was 0.89. The instrument total score was correlated with the VAS (r=0.644, p<0.01). Conclusions: We conclude that the MCQ-SF – Brazil Version has demonstrated satisfactory psychometric properties.

Correlation between difficulty & discrimination indices of MCQs in formative exam in Physiology.

Introduction: Difficulty index (P) and discrimination index (D) are the parameters used to evaluate the standard of multiple choice questions (MCQs) in examination. Accordingly the standard of MCQs can be interpreted as excellent, acceptable or poor. This study was intended to find out the standard of MCQs in formative examination in Physiology. The study also intended to find out correlation between P and D. Materials and Methods: There were 240 MCQ items, taken from the past 4 year batches of 100 students and were analyzed for level of difficulty and discrimination index. The relationship between them for each test item was determined by Pearson correlation analysis using SPSS 11.5. Results: There was a wide distribution of item difficulty indices (8.57 to 95.71) and discrimination indices (-0.54 to 0.8).The mean difficulty index (P) was 52.53 + 20.59 and mean discrimination index was 0.30+ 0.18. On average, about 23% of the MCQ items were easy (P >70%), while about 15% were difficult (P <30%). The remaining 62% items were within acceptable range (30 to 70%). In all 4% of the items showed negative discrimination and 21% of the items exhibited poor discrimination. The remaining 75% of the items were in the range of acceptable to excellent discrimination. The discrimination index exhibited slight positive correlation with difficulty index (r = 0.191, P=0.003<0.01). The maximal discrimination (D=0.6-0.8) was observed with moderately easy/difficult items (P = 40% - 60%). Conclusion: The majority (75%) of the items was acceptable as far as difficulty and discriminative indices were concerned. Moderately easy/difficult items had maximal discriminative ability. Too easy and too difficult items gave poor discrimination index. Negative discrimination was observed in only 4% of the items indicating faulty items or incorrect keys.

Association between presence in lectures and student knowledge gain in problem based learning: experience in Neuropsychiatry module, FMUI, International Program.

Aim This study was conducted to determine the association between presence in lecture and examination scores. Methods This was a cross sectional study, conducted in the Faculty of Medicine University of Indonesia, International Class Program, from November 2007 to May 2008. The subject’s inclusion criterion was FMUI International class students enrolled in the Neuropsychiatry module in 2007/2008. we excluded students who did not attend the examinations i.e. multiple choice questions (MCQ)-1, -2, or essay. The data collected were presence in lecture and examination scores. Data analysis was done using SPSS linear regression to see the association between presence in lectures and exam scores. Results The results showed that the R and P of the association between presence in lectures and exam scores were (R= 0.121, P= 0.413), (R= 0.212, P= 0.148), (R= 0.260, P= 0.075), and (R= 0.280, P= 0.054) for MCQ1, MCQ2, essay, and mean exam scores respectively. Conclusion We failed to show the association between presence in lectures and student knowledge gain. This result might be due to the many factors discussed that were not analyzed in this study.