The Long and Short of Summative Assessment in Competency Based Medical Education: Time to Raise the Bar?

BACKGROUND: The Competency-based medical education (CBME) has been introduced for MBBS programme in India from 2019. Reorganization of the assessment system is required to meet the challenges imposed by this new framework. OBJECTIVES: An evaluation of the university summative assessments held prior to the introduction of CBME-based curriculum was carried out to analyze the pattern, relevance and distribution of questions. METHODS: Five sets of annual and supplementary summative examination papers from three universities, State (SU), Private (PU) and Medical (MU) were evaluated. The analysis included format i.e. Structured and Modified Essay questions, Short notes, other formats; marks distribution; terminology-based level of cognitive domain; subject-based relevance and topic-based distribution of questions. RESULTS: A total of 352 questions were analyzed. The maximum number of questions were from the state university (140, 39.7%).The contribution of short notes in the theory papers was 65.8% (PU), 87.1% (SU) and 88.9% (MU).Only the PU had Modified-Essay Questions (10.5%) and Modified short notes(4.7%). Terminology addressing higher cognitive domains was low as the questions assessed mainly the knowledge level (80-96.8%), comprehension 3.1%-6.4%. Only the PU had problem solving questions comprising 11.7% of total questions. Majority of questions had moderate or high relevance and only 2.1%-8.2% were of low-relevance. Inter-university differences in the topics were observed for dermatology, psychiatry, and infections. CONCLUSIONS: The present evaluation of high-stakes assessment in three universities indicates minor differences in the format of questions. Questions were predominantly in the form of short notes, structured essays and modified essays were a rarity; few questions targeted higher cognitive levels although majority had high-moderate relevance.

Population genetic variation of SLC6A4 gene, associated with neurophysiological development.

The serotonin transporter 5-HTT is encoded by a single gene SLC6A4. Polymorphisms in SLC6A4 has been associated with a wide variety of neurological and psychiatric disorders including increased risk of posttraumatic stress disorder, higher likelihood for depression, obsessive-compulsive disorder (OCD), increased hostility and criminal behaviour. Genes associated with complex diseases often exhibit strong signatures of purifying selection compared to others. Further, discernible population specific variation in the signature of natural selection have been observed for several complex disease-related genes. In this project we aimed to investigate the population genetic variation of the serotonin transporter gene (SLC6A4), focussing on the single nucleotide polymorphisms (SNPs). To this end, we employed 2504 individuals around the globe available in 1000 Genome project Phase III data and classified them into five ethnic groups: Americans (AMR), Europeans (EUR), Africans (AFR), East Asians (EAS) and South Asians (SAS). Principal component analysis (PCA) performed on all annotated SNPs of SLC6A4 depicted clear clustering between Africans and the rest of the world along PC1, and East Asians and other non-African populations along PC2. Further, these SNPs were found to be under strong selection pressure especially among East Asian populations with significantly high positive cross-population extended haplotype homozygosity scores compared to Africans, indicating that SLC6A4 has likely undergone a strong selective sweep among the East Asians in the recent past. Our study can potentially explain the association between polymorphisms in SLC6A4, and major depression and suicidal tendencies among people of East Asian ancestry and the absence of such associations among people of European ancestry.

Evaluation of a personal and professional development module in an undergraduate medical curriculum in India.

The study aimed at evaluating the personal and professional development (PPD) module in the undergraduate medical curriculum in Melaka Manipal Medical College, India. PPD hours were incorporated in the curriculum. A team of faculty members and a faculty coordinator identified relevant topics and students were introduced to topics such as medical humanities, leadership skills, communication skills, ethics, professional behavior, and patient narratives. The module was evaluated using a prevalidated course feedback questionnaire which was administered to three consecutive batches of students from March 2011 to March 2013. To analyze faculty perspectives, one to one in-depth interviews and focus group discussions were conducted by the coordinators with faculty members who conducted the PPD classes. Analysis of the course feedback form revealed that majority (80%) of students agreed that the module was well prepared and was "highly relevant" to the profession. Faculty found the topics new and interdisciplinary and there was a sense of sharing responsibility and workload by the faculty. PPD modules are necessary components of the curriculum and help to mould students while they are still acquiescent as they assume their roles as doctors of the future.