ABSTRACT
Objective. To determine what expert assessors value when making pass-fail decisions regarding pharmacy students based on summative data from objective structured clinical examinations (OSCE), and to determine the reliability of these judgments between multiple assessors. Methods. All assessment data from 10 exit-from-degree OSCE stations for seven borderline pharmacy students (determined by standard setting methods) and one control was given to three of eight assessors for review. Assessors determined an overall pass-fail decision based on their perception of graduate competency. Assessors were interviewed to determine their decision-making rationale. Intraclass correlation coefficients were used to calculate reliability between assessor judgments. Results. Expert consensus was achieved for three of the eight students, however, the assessors' decisions did not align with standard-setting results. The reliability of assessors' decisions was poor. Assessors focused on ability to make correct recommendations rather than on gathering information or providing follow-up advice. Global evaluations (including a student's communication skills) rarely influenced the assessors' decision-making. Conclusion. When faced with making pass-fail decisions for borderline students, the assessors focus on evaluating the same competencies in the students but differed in their expected performance levels of these competencies. Pass-fail decisions are primarily based on task-focused components instead of global components (eg, communication skills), despite that global components are weighted the same for scoring purposes.
Subject(s)
Clinical Competence/standards , Educational Measurement/methods , Decision Making , Education, Pharmacy , Humans , Physical Examination , Students, PharmacyABSTRACT
Malaria is one of the most common parasitic infections worldwide. Plasmodium falciparum is the most prevalent strain in Africa and also the most fatal. The disease especially affects children, with those under age 5 years accounting for approximately 86 % of malaria deaths in 2010. The objectives of this review are to summarize and evaluate published literature reporting the pharmacokinetic parameters of artemisinin-based combinations used to treat P. falciparum in paediatric populations and to identify and discuss controversies regarding pharmacokinetics of these agents in children. A search of MEDLINE (1948-September 2012), EMBASE (1980-September 2012), International Pharmaceutical Abstracts (1970-September 2012), Google and Google Scholar was conducted for articles describing pharmacokinetics of antimalarials in children. Our search produced 30 articles, of which 23 were included in the review: artemisinin compounds, 12 articles; lumefantrine, four articles; amodiaquine, five articles; sulfadoxine, six articles; pyrimethamine, one article; mefloquine, three articles; and piperaquine, two articles. Studies were summarized based on comparison groups and major findings. Many controversies were identified, including pharmacokinetic equivalence of novel dosage forms, altered pharmacokinetic parameters in children versus adults, effect of drug interactions, and association of pharmacokinetic changes with clinical outcomes. A large variation in pharmacokinetic parameters of many antimalarial agents was shown, which may be a consequence of the wide range of ages and/or bodyweights of each paediatric cohort. These studies may mask important associations with age and bodyweight and produce mean data that do not adequately represent the paediatric population as a whole. In order to properly assess the clinical implications of such pharmacokinetic changes and recommend safe and effective dosage regimens, there is an urgent need for dose-optimization studies for all recommended first- and second-line agents, along with the different drug formulations, used in paediatric populations with P. falciparum.
