Lessons on large-scale OSCE in Canadian Qualifying Examination Part II after post-graduate residency / 医学教育

<p>　Based on our experience of visiting the Medical Council of Canada and observing large-scale OSCE (objective structured clinical examination) in Canadian Qualifying Examination Part II , we report differences operation system, implementation status, and examination questions compared to Japan. This very important examination after the post-graduate residency program may provide several invaluable tips when we introduce nation-wide clinical performance examinations.</p>

1. Does the national examination for medical practitioners contribute to a seamless transition from under- to post-graduate medical education in Japan? / 医学教育

<p>　As medical safety attracts attention, it has become increasingly important to ensure the quality of medical education, and more emphasis has been placed on educational outcomes. An ideal form of training, in which medical students undergo medical education and then transfer to residency training seamlessly, can be conducted by setting general competencies required for all physicians as educational outcomes, as well as setting milestones in the process. Accomplishing competencies is the pillar of outcome-based education, and the assessment of students' achievements is important.<br>　The multilateral assessments of their competencies should be conducted, including written examinations, performance tests, observational assessments, and portfolios. In the existing national examination for medical practitioners, no such multilateral assessments are conducted. To promote seamless transition from under- to post-graduate education, it is important for the Faculty of Medicine and medical colleges to appropriately assess students' educational milestones as a condition of awarding them with degrees, in addition to the setting general competencies and such milestones.</p>

Analyses of Scores of Examinations for Practical Training in Clinical Skills and for Clinical Training and Scores of Graduation Examinations in Undergraduate Medical Students / 医学教育

We analyzed the scores of objective structured clinical examinations (OSCEs) and written examinations administered to fourth-year medical students after practical training in clinical skills and to fifth-year medical students after clinical training and scores of graduation examinations taken by sixth-year medical students. Correlations were analyzed among the scores of 96 students who had taken all 3 examinations during a 3-year period. Mean scores on examinations in the fourth, fifth, and sixth years were compared between sixth-year students who did or did not graduate and between graduating students who did or did not pass the national examination for medical practitioners in Japan. Significant correlations in the scores were found between 1) OSCEs and written examinations for fourth-year students versus those for the fifth-year students; 2) OSCE and written examinations for fourth-year students versus graduation examination scores for the sixth-year students; and 3) OSCE and written examinations for fifth-year students versus graduation examination scores for sixth-year students. In addition, the mean scores in the fourth and fifth years were significantly higher for sixth-year students who graduated and passed the national examination than for students who did not graduate or who graduated but failed the national examination. These results suggest that the practical training in clinical skills given to fourth-year students and the clinical training given to fifth-year students strongly affect the overall evaluation of the ability of sixth-year students and success on the national examination.

A Comparative Study of Undergraduate Examinations to Evaluate Medical Students' Performance and the National Examination for Medical Practitioners / 医学教育

To demonstrate the quality assurance of the comprehensive examination of sixth-year students at Nippon Medical School, 4 undergraduate examinations were compared with the national examination for medical practitioners (NEMP) using scatter graphs and Pearson's correlation coefficient. Of the 93 sixth-year students at Nippon Medical School, 57%(n=53) reported their scores on the NEMP in response to a request from the Academic Quality and Development Office. Correlation coefficients of the grade point average (years 1 to 5), average scores on graduation examinations of 24 subjects, scores on the trial examination of NEMP, and scores on the sixth-year comprehensive examination with overall scores on the NEMP were 0.62, 0.46, 0.68, and 0.63, respectively. These results suggest that the sixth-year comprehensive examination is more suitable than are graduation examinations for predicting the NEMP score.

Pooling System for Multiple-Choice Questions for the National Examination for Medical Practitioners. Results of a Field Study in Japan / 医学教育

The Ministry of Health and Welfare of Japan is planning a pooling system for multiple-choice questions (MCQs) for the national examination for medical practitioners. To clarify possible problems of such a system, a field study was performed by 10 medical schools in Japan using 90 MCQs from previous examinations. Nine hundred twenty-four 6th-year students participated in the field test. For each MCQ, the correct-response rates at the originating school and those obtained in the field test were significantly correlated. Thus, the correct-response rates to questions on the field test could be predicted from the rates at the originating schools. However, for each question the correct-response rate was significantly higher for students of the originating school than for students of other schools. In the national examination, care should be taken to prevent differences in scores on the basis of question sources.

Student Selection Methods for Medical School and Progress after Admission Follow-up Study at Yamaguchi University. 3. Relation of Interview Evaluation and Progress after Admission / 医学教育

The relation between results of interview evaluation and progress after admission, especially the need to repeat years of school, dropping out, and results of the national examination for medical practitioners, was investigated in 318 students. Among students who had been admitted on the basis of open entrance examination, those who had lower interview evaluations needed to repeat a year of school at least three times more often than did other students. Among students who had been amitted on the basis of recommendations of high school principals, no such difference was observed, probably owing to selection bias. On the other hand, students who repeated a year of school had a significantly higher failure rate on the national examination for madical practitioners than did other students.

Methods of Selecting Students for Medical School and Performance after Admission. Follow-up Study at Yamaguchi University. 1. Relation between Characteristics at Entrance Examination and Performance after Admission / 医学教育

A follow-up study of the relation between methods of selecting medical students and performance after admission was investigated. The subjects were 318 students who had entered our medical school from 1987 through 1989. Two hundred fiftynine students had passed open entrance examinations and 59 students had passed special examinations for those who had been recommended by their high school principals. We found that students who had earned a degree other than a medical degree had the best performance, as measured by academic records, promotion, and results of the national examination for medical practitioners. They were followed in descending order by students who had been admitted upon recommendations of high school principals, students who had passed open entrance examinations immediately after graduation from high school, students who had prepared for entrance examinations for 1 or 2 years after high school, and students who had prepared for 3 years or more.