Health sciences and medical college preadmission criteria and prediction of in-course academic performance: a longitudinal cohort study.

High School, Aptitude and Achievement Tests have been utilized since 2002 in Saudi Arabia for the purpose of student selection to health sciences and medical colleges. However, longitudinal studies determining the predictive validity of these so-called cognitive tests for in-course performance is lacking. Our aim was to assess the predictive validity of Saudi health sciences and medical school pre-admission selection tools for in-course performance over a three year period and therefore we conducted a retrospective review of pre-admission (High School Test, Saudi Aptitude and Achievement tests) and in-course academic performance data (Grade Point Average, GPA) for all students enrolled in undergraduate Health Sciences Colleges and College of Medicine, 2007-2010. Correlation and linear regression analyses were performed for the whole cohort. Data are reported on 87 of 1,905 (4.6 %) students who applied to Health Sciences and Medical Colleges. The results indicate that in-course GPA scores in year three were significantly positively correlated with High School (r = 0.65; p < 0.05), Aptitude (r = 0.65; p < 0.05) and Achievement (r = 0.66; p < 0.05) selection test scores. Furthermore, the High School Exam was the best predictor of achievement in year three. Regression analysis revealed that 54 % of the variance in predicting academic performance is explained by the three test scores. Results confirmed our hypothesis that High School, Aptitude and Achievement tests are statistically predictive of academic performance in health sciences and medical colleges. Further longitudinal, national work is nevertheless required to determine the extent to which pre-admissions cognitive and non-cognitive tests, socio-demographic and educational process variables predict undergraduate and postgraduate achievement and performance.

Quality of life in people with epilepsy in Sudan: An example of underserved communities in developing countries.

OBJECTIVES: The aim of this study was to investigate the quality of life (QOL) in people with epilepsy (PWE) living in Khartoum State, Northern Sudan. The region offers a model of urban and suburban communities in developing countries. METHODS: A cross-sectional study was carried out in the neurology clinic of Khartoum State Hospital and Omer Ibn Alkhatab Health Center in the suburb of Khartoum State. We interviewed PWE living in the city, the suburbs and adjacent villages. Our subjects were known to have been on antiepileptic drugs (AED) for at least 6 months. The impact of epilepsy on the QOL was assessed in the clinic using a 23-item questionnaire with graded scales and check-lists to explored demographic characteristics, seizure control, adverse effects of antiepileptic medication, physical harm, social and psychological impact and stigmatization. RESULTS: Fifty-two females and 48 males between the ages of 10 and 80 years were interviewed. Sixty percent of participants were between 20 and 39 years of age. While on AED treatment, 63% developed at least one seizure at any given time, 49% in the past 6 months and 27% in the past week. Twenty six percent experienced one or more side effect of AEDs. A significant number of respondents admitted that epilepsy had a negative impact on several aspects of their daily life activities, education and social functioning. Of individuals eligible for work, 17% were unemployed or had their job terminated because of epilepsy. Relationships with spouses were affected in 20 % of cases. Fifteen percent felt stigmatized by their illness. None of the participants had received any formal health education or counseling about epilepsy. CONCLUSION: Epilepsy has a significant impact on several aspects of QOL, particularly physical injury and socioeconomic functioning affecting PWE living in Khartoum State. Poor seizure control, a risk factor for impaired QOL, was common. The overall perceptions of QOL and self satisfaction as stated by our PWE was more favorable when compared to those in developed countries and the Gulf. Nevertheless, this could be more reflective of social circumstances and better seizure control, health education and counseling for PWE and their families is still encouraged and recommended.

Stress and coping strategies among Arab medical students: towards a research agenda.

BACKGROUND: Research conducted in the past ten years in the area of stress and coping among Arab medical students has identified some important issues, but other significant aspects have not yet been explored. OBJECTIVES: To provide a systematic review of studies reporting on stress, anxiety and coping among Arab medical students and to identify implications for future research. METHODS: PubMed was searched to identify peer-reviewed English-language studies published between January 1998 and October 2009 reporting on stress and coping among undergraduate Arab medical students. Search strategy used combinations of the terms: Arab medical student, stress, PBL, psychological distress, depression, anxiety and coping strategies. Demographic information on respondents, instruments used, prevalence data and statistically significant associations were abstracted. RESULTS: The search identified 8 articles that met the specified inclusion criteria. Within the limited range of Arab medical students studied, studies suggest these students have a high prevalence of perceived stress, depression and anxiety, with levels of perceived psychological stress as high as those reported in the international literature for medical students of other regions of the world. Limited data were available regarding coping strategies, the impact of stress on academic performance and attrition among Arab students. No data were available regarding the impact of problem-based learning on stress and coping. CONCLUSIONS: The existing literature confirms that stress, depression and anxiety are common among Arab medical students, as for students elsewhere. Little is known about the contribution of different curricula approaches to perceived stress and what coping strategies institutions and students apply to help alleviate stress. Large, prospective, multicentre, multi-method studies are needed to identify personal and curricula features that influence stress, depression, anxiety and coping strategies among Arab students.

First aid and basic life support skills training early in the medical curriculum: curriculum issues, outcomes, and confidence of students.

BACKGROUND: The importance of training physicians and other health care professionals in first aid and basic life support (BLS) is now widely recognized. The Faculty of Medicine and Health Sciences of the United Arab Emirates University have been offering formal training in these skills to 1st-year medical students since 1989. The aim of this study was to determine the efficacy of the program and the extent to which it provides students with confidence to perform skills on their own after training. DESCRIPTION: 165 of 180 male and female students comprising 3 cohorts (91.7% response rate) completed a self-administered anonymous questionnaire. The questionnaire contained open- ended and Likert-type questions regarding course organization, content, strengths and weaknesses, teaching--learning approaches, and skills development and confidence. The authors analyzed assessment outcomes and associations between self-perceived levels of confidence and ability to practice. EVALUATION: Students were uniformly enthusiastic and highly motivated by the program. Self-assessed confidence in ability to perform skills on their own after completing the program was moderately correlated with perceived frequency of opportunity to practice many skills. There was nevertheless a consistent desire for more practice time. CONCLUSIONS: The results suggest that the program provides students with sound basic knowledge and adequate practical skills in first aid and BLS and that adequacy of time and physical and human resources are important prerequisites to facilitate practice and engender confidence in skills.

Identifying characteristics that students, interns and residents look for in their role models.

OBJECTIVE: To identify characteristics which students, interns and residents look for in their role models. METHODS: A 45-item self-administered questionnaire was sent to a sample (n=96, response rate 80%) consisting of three groups: (1) students in years 3-6 of the medical curriculum (n=66); (2) interns (n=17) and (3) residents (n=13). The questionnaire contained characteristics that participants might use to describe excellent role models, grouped under five general headings: personality, clinical, research and teaching skills, and community service. Other characteristics mentioned by study subjects were qualitatively analysed using content analysis. RESULTS: Personality and teaching and clinical skills were ranked as the top three factors, and research skills and community service as the least important factors by 79 (82%) respondents. Qualitative analysis of characteristics described by respondents for their role models yielded 21 characteristics. These were clustered into three main themes: role models as teacher, physician and person. The most frequently mentioned characteristics were personal characteristics such as positive, respectful attitudes toward patients and their families, and staff and colleagues; honesty; politeness; enthusiasm; competence, and knowledge. Females rated nine personal characteristics significantly higher than males (P < 0.05). Interns and residents valued teaching enthusiasm and competence significantly more than students (P=0.01). Role models had a strong influence on the specialty choice of 53 (55%) respondents. CONCLUSION: Knowing the characteristics of excellent role models should help medical educators to formulate strategies to recruit, retain and develop them. Increasing exposure of a variety of excellent role models to aspiring medical practitioners should be encouraged.

Assessing confidence and competence of senior medical students in an obstetrics and gynaecology clerkship using an OSCE.

CONTEXT: Assessment of clinical confidence and competence of senior medical students during an obstetrics and gynaecology clerkship using an objective structured clinical examination (OSCE). METHOD: A questionnaire was distributed to senior medical students (n=47)to assess pre- and post-OSCE self-perceived confidence and competence in five clinical skills: history taking, performing pelvic examination, interacting and communicating with patients, clinical reasoning and dealing with difficult patient situations. Pre- and post-performance confidence levels were compared and correlated with OSCE scores. RESULTS: The five clinical skills were significantly interrelated (p=0.001). There was no significant difference in OSCE performances between male (n=16) and female (n=31) students. Pre- and post-OSCE confidence in performing pelvic examination was significantly higher in female than male students (p=0.01). Post-OSCE confidence in clinical reasoning and dealing with difficult patient situations only were significantly increased in both groups (p=0.01 and p=0.02, respectively). Pre- and post-performance confidence levels were not significantly correlated to OSCE scores. CONCLUSION: Of five clinical skills rated, self-confidence in clinical reasoning skills and dealing with challenging or complex patient problems only were significantly increased after an OSCE assessing competence. The content of some of our OSCE stations thus enhance confidence in these skills but psychometric and other characteristics of the OSCE such as duration and performance feedback mechanisms need further investigation.

Diagnostic radiology in an integrated curriculum: evaluation of student appraisal.

RATIONALE AND OBJECTIVES: This study determined student perceptions of the effectiveness of an integrated radiology curriculum in a 6-year undergraduate medical school program. MATERIALS AND METHODS: Student perceptions of the effectiveness of an integrated radiology curriculum were assessed with a self-administered questionnaire that was developed in house and consisted of Likert-type and open-ended items. The questionnaire was distributed to 1997-1998 and 1998-1999 cohorts of 2nd- to 6th-year medical students. Quantitative data were analyzed by using descriptive statistics. RESULTS: Ninety-nine of 173 students (57% response) returned completed questionnaires. Overall, students perceived integrated radiology teaching as satisfactorily achieved and useful in facilitating learning. Compared with students in the 2nd and final years of undergraduate medical education and training, those in years 3-5 considered integrated radiology teaching to be very effective. Results of the survey suggest future modifications to improve the effectiveness of integrated radiology teaching. CONCLUSION: Radiology can be successfully integrated into modern medical curricula. Student comments indicate the need to structure and organize the integrated teaching better and to introduce it earlier in the medical school curriculum.

Identifying core obstetric and gynecologic skills required of, and used by, graduates of the Faculty of Medicine and Health Sciences, United Arab Emirates University.

BACKGROUND: Acquisition of core practical skills by students assures quality and relevance of medical education. PURPOSE: To determine whether students and interns are acquiring core obstetric and gynecologic skills. METHODS: A self-administered questionnaire was sent to obstetric and gynecology clerkship coordinators (n = 3), consultants (n = 14), residents (n = 13); interns (n = 13) and final-year students (n = 29; n = 93, response rate = 77%, N = 72). The questionnaire contained a stimulus list of 21 clinical, 8 communication, and 5 professional skills. RESULTS: Of 34 listed skills, 24 were identified as core skills. At least 50% of consultants, faculty, and residents expected 28 core skills to be covered in the undergraduate program. At least 50% of interns believed that 21 core skills had been acquired at graduation. CONCLUSION: Our curriculum is facilitating acquisition of core obstetric and gynecologic skills.

Imprecise terms in UK medical multiple-choice questions: what examiners think they mean.

Many multiple-choice questions (MCQs) used in medical education in the UK contain undefined, imprecise terms. They are particularly common in true/false items and can be found in classroom tests, published examples of MCQs and, more importantly, in high-stakes examinations which determine a candidate's graduation or membership of a professional body. This study investigated imprecise terms used in some MB BS final examinations and the Part 1 Membership Examination of the Royal College of Physicians. It revealed that imprecise terms occur commonly, yet there is a wide range of opinion among the examiners themselves about their meanings. The numbers and variety of imprecise terms which were found in high-stakes MCQ examinations are described in this paper and details are given concerning the lack of consensus about their meanings as reported by the responsible examiners. A second type of construction error--disproportionately large numbers of 'true' branches--was also recorded. Exemplary practices do exist in MCQ quality assurance, but in the UK they are very much the exception rather than the rule. The findings of this investigation strongly indicate a need for change.

Relationships between students' clinical experiences in introductory clinical courses and their performances on an objective structured clinical examination (OSCE).

PURPOSE: To elucidate the link between the quantity and quality of clinical exposure gained by first-year clinical students in hospital settings and their performance on a subsequent comprehensive assessment of clinical skills (the objective structured clinical examination, or OSCE). METHOD: Data relating to educational activities and workload were collected for the second introductory clinical attachment undertaken by 152 (of 246) students in two British medical colleges prior to a joint comprehensive 22-station OSCE administered in May 1994. Pearson correlation coefficients were used as the main analytical tool to study the relationships between measures of clinical activity and total OSCE scores. RESULTS: In general, of 43 indices of the amount, nature, and quality of bedside, ward-based, or outpatient experience, only six correlated with OSCE scores. The strongest links were for whether students examined out-patients on their own (r = .2), whether the objectives had been made clear (r = .19) and the number of clinics attended (r = .18). Variables meeting the criteria were entered into a backwards stepwise regression analysis to predict total OSCE scores, but they explained only 23% of the variance. CONCLUSION: The association between clinical experience and educational outcomes remains poorly understood.

Nursing skills and practice.

This article discusses the value placed on basic nursing skills and practice in preregistration diploma programmes (Project 2000). The authors argue that the current emphasis on the early acquisition of theoretical knowledge must not underestimate the importance of practising basic skills for the development of students' confidence in clinical settings.

Project 2000 student wastage: a case study.

High wastage rates associated with the nursing profession were a contributory factor driving recent reforms in the form of Project 2000 (P2000). Such changes beg the question: to what extent has this new educational initiative affected current wastage patterns among nursing students? This paper examines whether or not this new initiative is having an effect on student wastage at a first-wave college of nursing, midwifery and health visiting which implemented P2000 in 1989. Thus far, 10 cohorts of students have been admitted on to the course, seven full-time and three part-time. It is hoped other institutions involved in nurse education and training may gain some beneficial insights from the lessons learnt and measures taken to stem wastage at the college described in this case study.