ABSTRACT
PURPOSE: An assessment of educational needs is essential for curricular reform in medical education. Using the conceptual framework of needs assessment, this study aimed to determine which content should be emphasized in teaching evidence-based medicine (EBM) skills to physician assistant (PA) students. METHODS: Key content areas were identified from the published literature and objectives for previous courses. A questionnaire-type needs assessment instrument was created and given to a graduating class of PA students (n = 21) at the University of North Dakota. The response format had two 5-option scales, one to assess current skill levels and the other to assess ideal skill levels. Means for each category were calculated, and a mean difference analysis was performed. RESULTS: An average mean difference of 0.5 was noted in 3 domains (information retrieval skills, writing skills, and overall gains), and a mean difference of 0.7 was noted in one domain (statistical skills). Items with a mean difference of ≥ 0.7 were identified for prioritization for curricular reform. Open-ended input from respondents substantiated the need for greater emphasis on these content areas. CONCLUSION: Several content areas related to EBM skills can be identified and prioritized through a systematically conducted educational needs assessment. This method can be used to identify discrepancies between the existing and ideal states of affairs in PA education.
ABSTRACT
Primary biliary diseases have been associated in several studies with various malignancies. Understanding the risk and optimizing surveillance strategy of these malignancies in this specific subset of patients are an important facet of clinical care. For instance, primary sclerosing cholangitis is associated with an increased risk for cholangiocarcinoma (which is very challenging to diagnose) and when IBD is present for colorectal cancer. On the other hand, primary biliary cirrhosis patients with cirrhosis or not responding to 12 months of ursodeoxycholic acid therapy are at increased risk of hepatocellular carcinoma. In this review we will discuss in detail the risks and optimal surveillance strategies for patients with primary biliary diseases.
ABSTRACT
BACKGROUND: This study investigated the impact of addressing item writing flaws, testing at low cognitive level and non-functioning distractors (< 5 % selection frequency) in multiple-choice assessment in preclinical medical education. METHOD: Multiple-choice questions with too high or too low difficulty (difficulty index < 0.4 or > 0.8) and insufficient discriminatory ability (point-biserial correlation < 0.2) on previous administration were identified. Items in Experimental Subgroup A underwent removal of item writing flaws along with enhancement of tested cognitive level (21 multiple-choice questions), while Experimental Subgroup B underwent replacement or removal of non-functioning distractors (11 multiple-choice questions). A control group of items (Group C) did not undergo any intervention (23 multiple-choice questions). RESULT: Post-intervention, the average number of functioning distractors (≥ 5 % selection frequency) per multiple-choice question increased from 0.67 to 0.81 in Subgroup A and from 0.91 to 1.09 in Subgroup B; a statistically significant increase in the number of multiple-choice questions with sufficient point-biserial correlation was also noted. No significant changes were noted in psychometric characteristics of the control group of items. CONCLUSION: Correction of item flaws, removal or replacement of non-functioning distractors, and enhancement of tested cognitive level positively impact the discriminatory ability of multiple-choice questions. This helps prevent construct-irrelevant variance from affecting the evidence of validity of scores obtained in multiple-choice questions.
