Evaluation of Situational Judgment Tests in student selection in Indonesia and the impact on diversity issues.

BACKGROUND: Internationally, medical selection relies heavily on prior academic attainment which has an adverse impact on the diversity of selected students. Since non-academic attributes are also important, this study aims to evaluate the use of a Situational Judgment Test (SJT) for selection and the impact on student diversity relating to gender, ethnicity and socio-economic status. Previous SJT research has almost entirely originated from a Western context and this study focuses on new evidence in a South East Asian context with a different demographic profile. METHODS: Thirty faculty members developed 112 SJT scenarios assessing professionalism, communication and self-awareness domains. The scenarios underwent a concordance stage where stakeholder input was sought on the content appropriateness, to define the item scoring key, followed by an initial psychometric evaluation with first and second year medical students (N = 436). Based on these results, 30 scenarios, consisting of 128 nested items, were selected for pilot testing and evaluation regarding diversity issues with two cohorts of applicants in 2017 (N = 446) and 2018 (N = 508). RESULTS: The SJT demonstrated good internal consistency (Cronbach's alpha of 0.80 and 0.81 respectively). There were significant differences in SJT scores based on gender in both years, where females consistently outperformed males (p = .0001). However, no significant differences were found based on high school origin, parental educational background or ethnicity. CONCLUSIONS: This is the first study to evaluate the use of an SJT in Indonesia, which has a unique diversity profile compared to Western countries. Largely, the preliminary results replicate previous studies of the potential diversity benefits of using an SJT as a tool for medical student selection and has the potential to level the playing field regarding socio-economic status and ethnicity. Further studies exploring more variables representing diversity are warranted to confirm the early results in this study.

Spontaneous subarachnoid hemorrhage due to arteriovenous malformation mimicking migraine: A case report.

Subarachnoid hemorrhage (SAH) due to Arteriovenous Malformation (AVM) is a rare emergency case, which is often misdiagnosed as migraine. Here we present a case of SAH due to AVM that mimics migraine. A 41-year-old man came with headaches that radiated to the neck, worsened in the last week, accompanied by nausea, vomiting, photophobia, and a history of intermittent headaches for the previous 2 years. Physical examination was within normal limits, initial laboratory tests showed leukocytosis, and CT scan was not typical. The patient was diagnosed with migraine. Apparently, the lumbar puncture showed very high red blood cells, suspected as SAH. CT angiography revealed an extra-axial AVM. The patient was later diagnosed as SAH due to AVM. We recommend applying 4 key points, namely headache progressivity, neck pain, neck stiffness, and leukocytosis, to differentiate SAH due to AVM from migraine, especially in areas with limited facilities.

Potential of Hibiscus sabdariffa Linn. in managing FGF21 resistance in diet-induced-obesity rats via miR-34a regulation.

BACKGROUND: Obesity is a cause of FGF21 resistance, which affects the browning and thermogenesis process of the adipose tissue. Decreased receptor expression is influenced by miR-34a, whose expression is increased in obesity. While FGF21-based therapies have been widely investigated, the potential activity of Hibiscus sabdariffa Linn. extract (HSE) against FGF21 resistance is unknown. OBJECTIVE: This study aims to determine the effects of HSE on the expression of miR-34a and FGF21 receptors in white adipose tissue. METHODS: This experimental study used 24 male Sprague-Dawley rats and divided into four groups: Control (N); diet-induced-obesity rats (DIO); DIO rats with HSE 200 mg/kgBW/day and DIO rats with HSE 400 mg/kgBW/day. Rats were fed a high-fat diet for 17 weeks. HSE was administered daily for 5 weeks. The administration of HSE 400 mg/kgBW/day resulted in the equivalent expression of miR-34a to that of the control (p > 0.05). RESULTS: FGFR1 receptor expression was also similar to controls (p > 0.05). Beta-klotho expression was significantly lower than that of control (p < 0.05) but equivalent to that of DIO rats (p < 0.05). CONCLUSIONS: H. sabdariffa has the potential to reduce FGF21 resistance in DIO rats through the suppression of miR-34a expression and an increase in the number of FGFR1 and beta-klotho receptors in adipose tissue.

Intractable singultus as an initial symptom of medulla oblongata tuberculoma: A rare case report.

Tuberculoma of medulla oblongata is a rare manifestation of central nervous system tuberculosis (CNS TB), which may manifest as intractable singultus as the initial symptom. It is almost impossible to obtain definite diagnosis through biopsy consider its location. Immediate thorough diagnostic workup is needed, and empirical treatment should be started. We report a case of medulla oblongata tuberculoma in an HIV-negative 38-year-old man with intractable singultus as one of the early symptoms. He was treated empirically with anti-tuberculosis therapy and his symptoms subsided within 2 weeks.

Adaptation of internet-based multiple mini-interviews in a limited-resource medical school during the coronavirus disease 2019 pandemic.

The coronavirus disease 2019 pandemic has affected many aspects of life, including medical education. The selection of students using multiple mini-interviews (MMI) should be adapted promptly as internet-based MMI (iMMI) in the current setting. The current transition from MMI to iMMI is supported by experience in conducting conventional MMI in previous years; hence, the station and assessor preparation could be completed without significant issues. The greater challenges to the use of iMMI are due to technical issues, including poor internet connections and adaptations necessary for assessing candidates' nonverbal expressions. This paper aims to describe the experience of conducting iMMI in the current pandemic situation, with further highlights on contextual challenges in a limited-resource setting.