The probability of passing at resits in the Part I Fellowship examination.

The study aimed to determine the relationship of a candidate's attempt number and proximity of the aggregate score to the pass mark, individually and in combination, to the probability of passing at the next attempt at the Part I FRACS examination. The results of 36 examinations, in which 3513 candidates sat 5891 tests, were analysed. While 40.5% of all candidates who sat these examinations passed, the first attempt pass rate was 44%. Overall about one-third of the candidates who had sat the examination previously passed at the next attempt, the probability of passing remained fairly constant up to the fourth attempt and fell thereafter. As expected, the further the candidate's aggregate score was below the pass mark, the lower the probability of passing at the next attempt. Considering both attempt number and proximity to the pass mark, probability of passing decreased with successive attempts except for very weak candidates. The results indicate that, while the imposition of an upper limit on the number of resits at the examination is not justified, candidates who fall significantly below the pass mark should be advised against resitting for a reasonable period, and those who repeatedly do so should be advised against resitting for a reasonable period, and those who repeatedly do so should another career. It is suggested that feedback to the candidates about the probability of passing at the next attempt be based on the results obtained in this study.

Comparison of the performance of visual and verbal multiple-choice questions.

A study was carried out to determine whether multiple-choice questions based on visual trigger material, such as micrographs, photographs or radiographs, were more difficult and more discriminating than corresponding verbal questions testing: (i) the same information; (ii) different information in the same content area. Seventy-seven question triplets, each of which contained a visual (X) question, a verbal (Y) question testing the same information and a verbal (Z) question testing different information in the same content area were set in twelve Part 1 FRACS examinations. The questions were arranged in such a way that the X and Z questions in a triplet were set in the same examination, while the Y question was set in the corresponding examination of the previous or the following year. The specific outcomes studied were those on facility index and r biserial discriminating index. An analysis of variance on the data pertaining to each index did not indicate significant differences among the groups. None of the differences between pairs of mean facility indices among question groups X, Y and Z was found to be significant at P less than 0.05, nor were any of the differences between pairs of r biserial discriminating indices found to be significant at P less than 0.05. It was concluded that visual questions set in the Part 1 FRACS examination were not demonstrably more difficult or more discriminating than the corresponding verbal questions. The findings do not detract, however, from the obvious importance of visual recognition for future surgeons.

Effects of publishing multiple-choice questions on their subsequent item analysis.

A prospective study was carried out to determine what effects publication within a multiple-choice question (MCQ) book of 63 selected items from a bank had on their performance in subsequent examinations. A closely corresponding group of 63 unpublished questions set both before and after publication of the book was used as control. The specific outcomes studied were those on facility index, r biserial discriminating index and differences in performance between abler (upper 25%) and weaker (lower 25%) candidates. The mean facility index of the published questions increased significantly (P less than 0.01) after publication, while no significant change was observed in the mean facility index of control questions (P greater than 0.05) or in the mean discriminating index of published (P greater than 0.05) and control (P greater than 0.05) questions. Contrary to expectations the mean facility index of published questions increased, after publication, to a greater extent (P less than 0.01) for abler candidates than for weaker candidates. The study supports the hypothesis that publication of questions from a bank makes them easier to answer. The practice of adjusting the cut-off mark for passing according to the proportion of published questions in a given examination, however, is not justified. The findings highlight the need to advise less able candidates to make greater use of the MCQ book in preparing for an examination.

Gastric and intestinal bleeding in multiple neurofibromatosis with cardiomyopathy.

A case of multiple neurofibromatosis is described with histologically divergent lesions in the jejunum, stomach and colon presenting with bleeding and complicated by idiopathic hypertrophic subaortic stenosis. An aggressive surgical approach to gastro-intestinal bleeding in multiple neurofibromatosis is recommended.

A long standing, much travelled rectal foreign body.

A case is reported of a plastic vibrator which was successfully removed from a 64-year-old male after having been resident in his rectum for a period of six months, during which time the patient endured a world trip, making it the longest standing, most travelled foreign body introduced into the rectum yet reported.

Acute toxic dilatation of the colon in Crohn's colitis.

Twelve new cases of acute toxic dilatation of the colon in Crohn's colitis treated by total colectomy and ileorectal anastomosis are reported, and criteria for making the diagnosis are given.The complication has occurred in 6% of patients diagnosed as having Crohn's disease of the colon treated at the Gordon Hospital since 1948. The patients have been predominantly young adult females, with a short preoperative history of disease. The sigmoidoscopic appearance of the rectum preoperatively has been no indication of the likelihood of recurrent disease at the anastomosis. Only four patients still have successfully functioning ileorectal anastomoses and four patients have died from the effects of the disease.