Histórico de conceitos do Enade dos cursos de Odontologia da Bahia / History of Enade concepts of Dentistry courses in Bahia

O Exame Nacional de Desempenho dos Estudantes (Enade) é uma parte integrante do Sistema Nacional de Avaliação em Educação Superior (Sinaes).O exameé realizado a cada três anos pelos discentes concluintes dos cursos de graduação com o intuito de mensurar o rendimento dos alunos em relação ao curso ofertado. O objetivo deste estudofoi descrever a série histórica dos conceitos no Enade do curso de Odontologia de instituições de ensino superior (IES)particulares e públicas do estado da Bahia, nos anos de 2004a2019,e realizar um comparativo dos conceitos obtidos pelas IES ao longo deste período. Foi realizada pesquisa observacional descritiva retrospectiva em arquivos públicos disponibilizados no siteoficial do Instituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira (INEP) de todos os conceitos Enade dos cursos de Odontologia na unidade baiana da federação.Os dados obtidos foram submetidos à análise descritiva por meio da média e desvio-padrão dos conceitos.Asinstituições particulares obtiveram médiados conceitos de2,78±0,72no período pesquisado,não havendodiferença de desempenho entre elas, aexceção foi o curso de Odontologia daEscola Bahiana de Medicina e Saúde Pública (EBMSP), que alcançou conceitos 4 e 5 em 3exames, não consecutivos,da série. As instituiçõespúblicas apresentaram média dos conceitosde 4,05±0,83. AUniversidade Federal da Bahia (UFBA)obteve média de 4,33. As IES públicas obtiveram melhor resultado em conceito do Enadeem relação ao dasIES particulares.A UFBA foi a IES baiana de Odontologia mais bem avaliada ao longo da série histórica considerada (AU).

The National Exam of Students Performance (Enade) is an integral part of the National Higher Education Assessment System (Sinaes). Enade is held every three years by students completing undergraduate courses in order to measure student performance in relation to the course offered. The aim of this study was to describe the historical series of concepts in Enade of the Dentistry course of private and public Institutions of Higher Education (IES) in the state of Bahia, in 2004, 2007, 2010, 2013, 2016 and 2019and to compare the concepts obtained by IES throughout this period. A retrospective descriptive observational research was carried out in public files available on the official website of the National Institute of Educational Studies and Research Anísio Teixeira (INEP) of all Enade concepts of Dentistry courses in the Unit of the Federation of Bahia. Thedata obtained were submitted to descriptive analysis by the mean and standard deviation of the concepts. Private institutions had an average score of 2.78±0.72 in the period surveyed, with no difference in performance between them, with the exception of the Dentistry course of Bahia School of Medicine and Public Health (EBMSP), which attained scores 4 and 5, in 3 exams. Public institutions had an average score of 4.05±0.83 in the concepts. The Federal University of Bahia (UFBA) obtained an average score of 4.33. Public IES obtained better results in the Enade concept than private IES. UFBA was evaluated as being the best IES of Dentistry in Bahia throughout the historical series considered (AU).

Discontinuation of the USMLE Step 2 Clinical Skills Examination: Studying the Past to Define the Future.

The United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills (CS) was discontinued in January 2021, marking a significant milestone in assessment of clinical skills. In this commentary, the authors trace the history of the Step 2 CS exam-beginning with its early roots in the 1960s up to its discontinuation in 2021. In this new era, the medical education community is replete with opportunities for advancing methodology and content associated with clinical skills assessment. The authors propose 3 main lessons gleaned from this rich history and modern evolution, which are aimed at defining a future that includes creative collaboration toward development of comprehensive, equitable, student-focused, and patient-centered clinical performance assessment. First, as it has done throughout history, the medical education community should continue to innovate, collaborate, and improve upon methods of clinical skills assessment. Second, medical educators should continue to shift to more complex and student-driven approaches of assessment, that is, assessments that provide an unstructured environment, are realistic with respect to the natural conditions, and do not limit students to lists of options or force them to take a certain path of reasoning. Third, medical educators should continue to rethink the role of assessment and ensure that all assessments, regardless of stakes or type, provide sufficient feedback for the student to identify areas of strength and weakness.

A history of assessment in medical education.

The way quality of assessment has been perceived and assured has changed considerably in the recent 5 decades. Originally, assessment was mainly seen as a measurement problem with the aim to tell people apart, the competent from the not competent. Logically, reproducibility or reliability and construct validity were seen as necessary and sufficient for assessment quality and the role of human judgement was minimised. Later, assessment moved back into the authentic workplace with various workplace-based assessment (WBA) methods. Although originally approached from the same measurement framework, WBA and other assessments gradually became assessment processes that included or embraced human judgement but based on good support and assessment expertise. Currently, assessment is treated as a whole system problem in which competence is evaluated from an integrated rather than a reductionist perspective. Current research therefore focuses on how to support and improve human judgement, how to triangulate assessment information meaningfully and how to construct fairness, credibility and defensibility from a systems perspective. But, given the rapid changes in society, education and healthcare, yet another evolution in our thinking about good assessment is likely to lurk around the corner.

Histology and Embryology Education in China: The Current Situation and Changes Over the Past 20 Years.

In mainland China, histology and embryology (HE) are taught in one course as an essential component of medical curricula. The effectiveness of HE courses directly affects the quality of medical students. To determine the present situation and changes in HE teaching in Chinese medical schools, a nationwide survey was conducted among the HE departmental leaders. In total, 66 responses were included in the study, representing prominent Chinese mainland medical schools. The results revealed that most HE teachers have medical educational backgrounds; an increasing number of teaching staff with PhDs have joined the teaching staffs. A range of 71 to 90 HE curriculum contact hours is predominant. The ratio of theory to practice for HE contact hours is 1:1 at half of the surveyed medical schools. The numbers of students in each laboratory are less than 30 and from 31 to 60 at 23 and 36 medical schools, respectively. Virtual microscopy is employed in 40% of the surveyed medical schools. Didactic teaching is the most common strategy, although new teaching approaches are being employed gradually. During the past 20 years, both the total number of HE teachers and the number of HE teachers with medical educational backgrounds have been reduced in at least half of the surveyed schools. A total of 83.33% of the surveyed schools have reduced their HE contact hours. Almost half of the Chinese medical schools remained unchanged in both their ratio of theory to practice and the number of students in each laboratory. The data derived from this study help to understand the development of the HE discipline at Chinese medical schools.

A Crisis of Trust Between U.S. Medical Education and the National Board of Medical Examiners.

This Invited Commentary is an independent opinion piece and companion to the Perspective by Carmody and Rajasekaran that appears in this issue of Academic Medicine. The National Board of Medical Examiners (NBME), a 501(c)(3) nonprofit, is a powerful gatekeeper to the medical profession in the United States. According to publicly available tax data, the NBME, which has increased its number of income-enhancing products, had revenues of $153.9 million (M) and net assets of $177.6M in 2017, earnings (revenue less expenses) of $39.7M in 2013-2017, and a highly compensated management team. Medical students are ultimately the source of nearly all the NBME's revenue, and the NBME has contributed to the growth of medical student debt. The NBME has operated as a monopoly since its agreement in the early 1990s with the Federation of State Medical Boards to cosponsor the United States Medical Licensing Examination (USMLE). Although the NBME has developed valuable products and is ostensibly governed by a capable board, the NBME has inherent financial conflicts of interest and may be benefiting from the current "Step 1 mania" undermining undergraduate medical education. Here, the author makes 4 recommendations to reestablish the trust of the U.S. medical education community in the NBME: (1) the NBME should recuse itself from current discussions and policy-making decisions related to changes in the score reporting of the USMLE Step 1 exam; (2) the NBME should disclose and be transparent about all aspects of its finances; (3) new NBME products, changes in pricing, and changes to pass thresholds should be approved by an oversight committee, independent of the NBME; and (4) the NBME (and USMLE) should not charge students or residents for retaking any of its licensing examinations.

Historia y realidad de los hospitales universitarios españoles / History and reality of the Spanish University hospitals

Existen muchos entornos asistenciales que pueden y deben participar activamente en la enseñanza práctica de la medicina, pero no se puede concebir una facultad de medicina sin un hospital docente con las características básicas que se describen en este documento. El sistema de comisiones mixtas se ha mostrado ineficaz y su funcionamiento es deficiente en la mayoría de las universidades. Desde hace años, la Conferencia de Decanos de Facultades de Medicina de España viene demandando la reforma del Real Decreto 1558/86 y el establecimiento de estándares claros en relación con el tipo de profesorado, los espacios físicos, la infraestructura y los recursos materiales necesarios para ejercer las labores docentes e investigadoras en los hospitales universitarios. También se requiere fijar unos criterios de calidad mínimos y el sistema que permita cuantificarlos. En definitiva, una evaluación por objetivos con auditorías rigurosas que conduzcan a la renovación o la revocación de la condición de "universitario" para todo hospital que opte al nivel de excelencia que esta denominación implica. En este artículo se proponen, con una óptica realista y pragmática, algunos de los criterios que deberían contemplarse

There are many clinical environments that might and should be used in the practical training of medical students, but it is inconceivable that a Medical School could exist without a teaching hospital with the basic features described in this document. The joint committee's system has proven to be inefficient in most universities. For years now, the RD 1558/86 reform has been an important item on the National Conference of Deans of the Spanish Medical Schools (CND) agenda. The CND has also been asking for clear policies and standards concerning clinical teachers, physical spaces, infrastructure, equipment and material resources which are necessary to carry out teaching and research activities at university hospitals. A set of minimum quality criteria and a system which makes it possible to check them is also required. In the end, a targeted evaluation and stringent audits that could imply the renewal or revocation of the "universitary" qualification of a hospital is mandatory. In this article, we propose some of the criteria that should be considered with a realistic and pragmatic view

The Evolution of the American Board of Ophthalmology Written Qualifying Examination.

Since the inception of board certification in ophthalmology in 1916, a written assessment of candidates' knowledge base has been an integral part of the certification process. Although the committee structure and technique for writing examination questions has evolved over the past 100 years, the written qualifying examination remains an essential tool for assessing the competency of physicians entering the workforce. To develop a fair and valid examination, the American Board of Ophthalmology builds examination questions using evidence-based, peer-reviewed literature and adheres to accepted psychometric assessment standards.

History of the American Board of Ophthalmology Oral Examination.

The oral examination has been an integral part of certification by the American Board of Ophthalmology (ABO) since its founding in 1916. An overview is provided regarding the history, evolution, and application of new technology for the oral examination. This part of the certifying process allows the ABO to assess candidates for a variety of competencies, including communication skills and professionalism.

Measurement, Certification, and Quality: Meeting Enduring Challenges with Modern Tools.

The author, a former chair of the ABIM, describes the challenges that the board certification enterprise is experiencing as medicine shifts from being a paper-based to a digital industry. While there are clearly threats to board certification, he argues that boards can remain highly relevant if they focus on areas in which they can make unique contributions, such as the measurement of cognitive skills, diagnostic accuracy, "keeping up," and procedural skills.

Psychometrics and its discontents: an historical perspective on the discourse of the measurement tradition.

Psychometrics has recently undergone extensive criticism within the medical education literature. The use of quantitative measurement using psychometric instruments such as response scales is thought to emphasize a narrow range of relevant learner skills and competencies. Recent reviews and commentaries suggest that a paradigm shift might be presently underway. We argue for caution, in that the psychometrics approach and the quantitative account of competencies that it reflects is based on a rich discussion regarding measurement and scaling that led to the establishment of this paradigm. Rather than reflecting a homogeneous discipline focused on core competencies devoid of consideration of context, the psychometric community has a history of discourse and debate within the field, with an acknowledgement that the techniques and instruments developed within psychometrics are heuristics that must be used pragmatically.

A history of the American Board of Surgery: vignettes from the certifying examination: The Edgar J. Poth Memorial Lecture.

The American Board of Surgery was established in 1937 to certify surgeons who through training, experience, and examination meet the highest standards of surgical care. This lecture was given as the Edgar Poth lecture at the April 2015 meeting of the Southwestern Surgical Congress. Dr Poth was a surgical educator from the University of Texas Medical Branch, Galveston who was President of the Southwestern in 1963. The paper presents the history of the founding of the American Board of Surgery, with particular emphasis on the certifying examination-Part 2. Vignettes of occurrences associated with the "Oral" examination are given. The examination has changed substantially from a 2-day event involving an actual surgical procedure to the 90-minute quiz given today. The oral examinations remain an important part in the process of certification of surgeons of the highest quality.

Teaching More by Grading Less (or Differently).

When we consider the practically universal use in all educational institutions of a system of marks, whether numbers or letters, to indicate scholastic attainment of the pupils or students in these institutions, and when we remember how very great stress is laid by teachers and pupils alike upon these marks as real measures or indicators of attainment, we can but be astonished att he blind faith that has been felt in the reliability of the marking systems.

[Examinandi, doctors and medical councils. Reform proposals concerning surgico-medical education and examinations at the University of Vienna around 1800]. / Examinandi, Doktoren und medizinische Kollegien. Reformpläne für die medizinisch-chirurgische Lehre und Prüfungsordnung an der Universität Wien um 1800.

This essay examines the workings of the so called Court Committee for the Revision of University Studies. The main duty of this institution was to evaluate the structure of the whole educational system of the Habsburg Empire. These records have not received much notice hitherto from historians of medicine. Nevertheless, they deserve attention, as they are quite full of information regarding the "how" of medical education and health care management around 1800. Johann Peter Frank, at that time professor at the Medical Faculty of Vienna was responsible for reform proposals. His deliberations shed fresh light not only on the structures of Viennese Medical Faculty itself but also on different educational policies in the medical sciences in Central Europe around 1800.