Predictors of disability in a childhood-onset systemic lupus erythematosus cohort: results from the CARRA Legacy Registry.

Objective Few descriptions of physical disability in childhood-onset SLE (cSLE) exist. We sought to describe disability in a large North American cohort of patients with cSLE and identify predictors of disability. Methods Sociodemographic and clinical data were obtained from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Legacy Registry for patients with cSLE enrolled between May 2010 and October 2014. The Childhood Health Assessment Questionnaire (CHAQ) was used to assess disability and physical functioning. Chi-square tests were used for univariate analyses, and multivariate logistic regression was used to assess predictors of disability. Results We analyzed data for 939 patients with cSLE. The median and mean CHAQ scores were 0 and 0.25, respectively, and 41% of the cohort had at least mild disability. Arthritis and higher pain scores were significantly associated with disability as compared to those without disability ( p < 0.001). In multivariate logistic regression analysis, low annual income, arthritis, and higher pain scores were associated with disability at baseline. Conclusions Disability as measured by baseline CHAQ was fairly common in cSLE patients in the CARRA Legacy Registry, and was associated with low household income, arthritis, and higher pain scores. In addition to optimal disease control, ensuring psychosocial supports and addressing pain may reduce disability in cSLE. Further study is needed of disability in cSLE.

Examining the influence of gender on medical students' decision making.

Gender bias, described among practicing physicians, has rarely been examined in medical students. The current study examined the influence of gender bias on medical students' clinical decision making. We experimentally manipulated patient gender in 27 written clinical vignettes embedded in the United States Medical Licensing Examination (USMLE) Step 2 examination (a multiple-choice test of clinical decision making). Female and male patient versions of selected test cases were created within three categories: (1) diseases with previously established evidence of gender bias in the diagnosis or management of the disease, (2) diseases with a higher prevalence in a specific gender, and (3) diseases with similar prevalence in both genders and without evidence of gender bias in the literature. Among the 3059 students who wrote the USMLE Step 2 examination in August 1998, there were small but significant differences in performance on the 12 gender bias cases. Students performed worse for the female patient version of the cases compared with the male patient version of the cases (mean of 55.8% correct for female cases compared with 57.7% correct for male cases) (p < 0. 01). Our data suggest that students were variably influenced by gender bias in their investigation and management of patients in a written test of clinical decision making.

Review of the score-reporting policy for the United States Medical Licensing Examination.

In 1998, the authors, acting on behalf of the National Board of Medical Examiners (NBME), undertook a review of the scoring policy for the United States Medical Licensing Examination (USMLE). The main goal was to determine the likely effect of changing from numeric score reporting to reporting pass-fail status. Several groups were surveyed across the nation to learn how they felt they would be affected by such a change, and why: all 54 medical boards; 1,600 randomly selected examinees (including 250 foreign medical graduates) who had recently taken either Step 1, Step 2, or Step 3 of the USMLE; 2,000 residency directors; the deans, education deans, and student affairs deans at all 125 U.S. medical schools accredited by the Liaison Committee on Medical Education; and all 17 members of the Council of Medical Specialty Societies. Responses from the different groups surveyed varied from 80% to a little less than half. The authors describe in detail the various views of the respondents and their reasons. Some members in each group favored each of the reporting formats, but the trend was to favor numeric score reporting. The majority of the responding examinees desired that their USMLE scores be sent to them in numeric form but sent to their schools and to residency directors in pass-fail form. Based on the responses and a thorough discussion of their implications, the Composite Committee (which determines USMLE score-reporting policy) decided that there is no basis at this time for changing the current policy, but that it would review the policy in the future when necessary.

Assessment in basic science instruction: directions for practice and research.

In this essay, we discuss assessment of students' understanding of the basic biomedical sciences during the basic science component of medical education. Because we strongly believe that assessment should follow from and be congruent with course and curricular goals, the first section discusses recent trends in basic science education: where it's been and where it appears to be headed. The second section discusses considerations in the design of an assessment system that reflects curricular goals and encourages students to achieve them; it also identifies some research issues that we think merit attention. In the last section, we outline some of the special assessment issues and problems that arise in the context of problem-based learning (PBL) and discuss the merits of some of these novel assessment approaches, as well as the use of more traditional methods in PBL curricula.