Validity Evidence for a Brief Online Key Features Examination in the Internal Medicine Clerkship.

PURPOSE: Medical educators use key features examinations (KFEs) to assess clinical decision making in many countries, but not in U.S. medical schools. The authors developed an online KFE to assess third-year medical students' decision-making abilities during internal medicine (IM) clerkships in the United States. They used Messick's unified validity framework to gather validity evidence regarding response process, internal structure, and relationship to other variables. METHOD: From February 2012 through January 2013, 759 students (at eight U.S. medical schools) had 75 minutes to complete one of four KFE forms during their IM clerkship. They also completed a survey regarding their experiences. The authors performed item analyses and generalizability studies, comparing KFE scores with prior clinical experience and National Board of Medical Examiners Subject Examination (NBME-SE) scores. RESULTS: Five hundred fifteen (67.9%) students consented to participate. Across KFE forms, mean scores ranged from 54.6% to 60.3% (standard deviation 8.4-9.6%), and Phi-coefficients ranged from 0.36 to 0.52. Adding five cases to the most reliable form would increase the Phi-coefficient to 0.59. Removing the least discriminating case from the two most reliable forms would increase the alpha coefficient to, respectively, 0.58 and 0.57. The main source of variance came from the interaction of students (nested in schools) and cases. Correlation between KFE and NBME-SE scores ranged from 0.24 to 0.47 (P < .01). CONCLUSIONS: These results provide strong evidence for response-process and relationship-to-other-variables validity and moderate internal structure validity for using a KFE to complement other assessments in U.S. IM clerkships.

How we developed and piloted an electronic key features examination for the internal medicine clerkship based on a US national curriculum.

BACKGROUND: Key features examinations (KFEs) have been used to assess clinical decision making in medical education, yet there are no reports of an online KFE-based on a national curriculum for the internal medicine clerkship. What we did: The authors developed and pilot tested an electronic KFE based on the US Clerkship Directors in Internal Medicine core curriculum. Teams, with expert oversight and peer review, developed key features (KFs) and cases. EVALUATION: The exam was pilot tested at eight medical schools with 162 third and fourth year medical students, of whom 96 (59.3%) responded to a survey. While most students reported that the exam was more difficult than a multiple choice question exam, 61 (83.3%) students agreed that it reflected problems seen in clinical practice and 51 (69.9%) students reported that it more accurately assessed the ability to make clinical decisions. CONCLUSIONS: The development of an electronic KFs exam is a time-intensive process. A team approach offers built-in peer review and accountability. Students, although not familiar with this format in the US, recognized it as authentically assessing clinical decision-making for problems commonly seen in the clerkship.

Potential role of the endocannabinoid receptor antagonist rimonabant in the management of cardiometabolic risk: a narrative review of available data.

The endocannabinoid system (ECS) is an endogenous physiological system composed of two cannabinoid receptors and several endogenous ligands. The ECS is intimately involved in appetite regulation and energy homeostasis, which makes it an intriguing target for pharmacological treatment of obesity, diabetes, and the metabolic syndrome. Rimonabant is the first cannabinoid receptor (CB-1) antagonist being studied and utilized to treat obesity (it is approved in Europe but is currently under review in the United States). Large randomized trials with rimonabant have demonstrated efficacy in treatment of overweight and obese individuals with weight loss significantly greater than a reduced calorie diet alone. In addition, multiple other cardiometabolic parameters were improved in the treatment groups including increased levels of high density lipoprotein cholesterol, reduced triglycerides, reduced waist circumference, improved insulin sensitivity, decreased insulin levels, and in diabetic patients improvement in glycosylated hemoglobin percentage. There was an increase in the adverse effects of depression, anxiety, irritability, and nausea in rimonabant-treated groups. This novel medication may become an important therapeutic option in the fight to reduce cardiovascular disease worldwide through its unique action on cardiometabolic risk.

Boolean search experience and abilities of medical students and practicing physicians.

BACKGROUND: Little is known about physician ability to utilize Boolean search skills to access information. PURPOSE: Determine the proficiency of medical students and practicing physicians to identify efficient Boolean phrases. METHODS: Experiential survey and multiple-choice questions administered to 49 4th-year medical students and 42 practicing physicians. Subjects identified the best answer or correctly ranked 3 Boolean search phrase options. RESULTS: Practicing physicians identified the single best query phrase significantly more often than did medical students (85.7% vs. 75.0%, p < 0.001), and both groups had significantly more difficulty correctly rank-ordering the queries (students, 75% vs. 54%, p < 0.001; practitioners, 85.7% vs. 57.1%, p < .04). Only recent MEDLINE use was an independent predictor of accuracy in both groups. CONCLUSION: Students and physicians demonstrated deficiencies in identifying optimal Boolean phrases. Although formal instruction has not demonstrated clear improvement in skills, more creative teaching of Boolean search techniques should be undertaken and tested.