Essential steps in the development, implementation, evaluation and quality assurance of the written part of the Swiss federal licensing examination for human medicine.

Purpose: This report describes the essential steps in the development, implementation, evaluation and quality assurance of the written part of the Swiss Federal Licensing Examination for Human Medicine (FLE) and the insights gained since its introduction in 2011. Methods: Based on existing scientific evidence, international expertise, and experience gained from previous examinations, the FLE is developed by experts from all five medical faculties in Switzerland with the support of the Institute for Medical Education and is held simultaneously at five locations. The exam organisers document and review every examination held and continuously optimise the processes; they have summarised the results in this report. Results: The essential steps comprise the development, revision and translation of questions; construction of the exam and production of materials; candidate preparation; implementation and analysis. The quality assurance measures consist of guideline coherence in the development of the questions and implementation of the exam, revision processes, construction of the exam based on the national blueprint, multiphase review of the translations and exam material, and statistical analysis of the exam and the comments from candidates. The intensive collaboration, especially on the part of representatives from all the participating faculties and a central coordination unit, which provides methodological support throughout and oversees the analysis of the exam, has proven successful. Successfully completed examinations and reliable results in the eleven examinations so far implemented represent the outcomes of the quality assurance measures. Significant insights in recent years are the importance of appreciating the work of those involved and the central organisation of exam development, thus ensuring the long-term success of the process. Conclusion: Common guidelines and workshops, quality assurance measures accompanied by the continuous improvement of all processes, and appreciation of everyone involved, are essential to carrying out such an examination at a high-quality level in the long term.

Do women tend while men fight or flee? Differential emotive reactions of stressed men and women while viewing newborn infants.

Infant care often is carried out under stressful circumstances. Little is known about differences in caretaking motivation between men and women under stress. In the present study, stress was induced in 40 participants (21 women, 19 men) by means of the cold pressor stress test, 40 (22 women, 18 men) serving as controls. Participants then rated their urge to care for newborn infants shown on 20 short video clips. The infants in the videos were either crying (N=10) or were showing typical neonatal facial movements (N=10). Skin conductance was obtained while participants viewed the videos and salivary cortisol was measured to capture stress responses. We found sex differences in caretaking motivation, such that stress led to decreased caretaking motivation in men but not in women. Furthermore, stressed men elicited a stronger skin conductance change while viewing infant videos than stressed women. These findings provide further evidence for differential stress reactions in men and women and may have crucial implications for parental care.

Modifications of recognition memory processes in preterm children: an event-related potential study.

Prematurity may cause hippocampal compromise. Therefore, hippocampus-dependent memory processes (recollection-based retrieval) may be more impaired than hippocampus-independent processes (familiarity-based retrieval). The memory of 18 children born preterm with reduced hippocampal volumes, without neonatal complications (weeks of gestation < 34, weight < 1,600 g), and 15 controls (8-10 years) was tested using an item recognition task. While groups were equal in memory performance, dissociation was found: The event-related potential (ERP) correlate of familiarity was intact in the preterm group, whereas the correlate of recollection was attenuated. A follow-up experiment ruled out that this was due to general cognitive deficits. Furthermore, gestational age correlated with the ERP index of recollection. Thus, recognition memory in preterm children may be characterized by a compensation of attenuated recollection by familiarity.

Alterations in the relationship between hippocampal volume and episodic memory performance in preterm children.

This study examines the relationship between episodic memory and hippocampal volume (magnetic resonance imaging [MRI] volumetry) in preterm children with uncomplicated neonatal courses (<34 weeks of gestation, birth weight <2,000 g) and controls (7-11 years). To examine episodic memory performance and retrieval processes, neuropsychological tests and a recognition experiment were used. Although preterm children showed reduced hippocampal volumes relative to controls by 12%, episodic memory accuracy was not reduced. However, only in controls hippocampal volume correlated with some measures of episodic memory. Together, behavioral and MRI results indicate a minor functional specificity of the hippocampus regarding episodic memory functions in preterm children.