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The core content for a medical specialty outlines the scope of the discipline as well as the categories of knowledge considered essential to practice in the field. It provides a template for the development of curricula for medical school, graduate, and postgraduate education, as well as for creating certification standards. Venous and Lymphatic Medicine (VLM) is a specialty that has benefitted from contributions from specialists from several medical disciplines. Optimally, the societies, boards, and residency review committees representing these disciplines would uniformly recognize the scope of VLM to develop education and assessment standards to allow training and identification of qualified practitioners. In order to inform the standard setting bodies and other stakeholders of the current scope of VLM, a task force of VLM experts from cardiology, dermatology, emergency medicine, general surgery, interventional radiology, vascular medicine, and vascular surgery was formed to revise a 2014 consensus document defining the core content of the specialty of VLM. [ABSTRACT FROM AUTHOR]

PROBLEM The purpose of assigning grades at the conclusion of a course is to convey the level of achievement of learners. However, with the presence of grade inflation in nursing education, it poses a great threat to the evaluation process. PURPOSE The purpose of this article is to highlight the factors that influence grade inflation and to explore possible solutions to minimize the incidence of grade inflation in nursing education. FINDINGS A review of the literature revealed that a variety of factors influenced grade inflation and educators were indeed lenient with their grading practices, which hence attenuates the purpose of grading and evaluation. CONCLUSION While it may be an arduous task for nursing faculty to evaluate nursing students, nursing faculty have the obligation to preserve academic integrity and must devise appropriate solutions to address the incidence of grade inflation in nursing education. [ABSTRACT FROM AUTHOR]

Multisource assessment (MSA) uses multiple assessors to provide feedback. Little is known about the validity of using MSA feedback for improving students' ability to self-assess in a preclinical environment. Therefore, the aim of this study was to measure the validity of using a defined reflective process involving an MSA tool for building skill in dental students' self-evaluation of caries excavation on extracted teeth. As part of this process, 104 first-year students at one U.S. dental school used a self-generated study plan (SGSP) for structured reflection on MSA feedback during the 2013-14 academic year. Interrater agreement, determined through calculation of percentage-agreements in scoring, was measured among three assessor groups (self-, peer, and expert assessors) in formative assessment and between two assessor groups (self- and expert assessors) in summative assessment two weeks apart, allowing for reflective practice and completion of an SGSP between assessments. Validity for improving self-assessment was determined by measuring significance in positive shifts of agreement between self- and expert assessors. The results showed that interrater agreement between the self- and expert assessors increased significantly: from a 28% agreement in formative assessment to a 60% agreement in summative assessment. Significance in percentage shifts between assessments was demonstrated with a McNemar score of 0.26 (p<0.001). These results suggest that the described MSA tool and reflective process in an SGSP may be valid methods for improving skill in student self-evaluation of competence in caries excavation on extracted teeth. [ABSTRACT FROM AUTHOR]

Objectives: Challenges in healthcare demand great leadership. In response, leadership training programs have been developed within academic medical centers, business schools, and healthcare organizations; however, we are unaware of any well-developed programs for physicians-in-training.Methods: To address this gap, we developed a two-day leadership development course for chief residents (CRs) at the Cleveland Clinic, framed around the concept of emotional intelligence. This paper describes our five-year experience with the CRs leadership program.Results: Since inception, 105 CRs took the course; 81 (77%) completed before-and-after evaluations. Participants indicated that they had relatively little prior knowledge of the concepts that were presented and that the workshop greatly enhanced their familiarity with leadership competencies. Qualitative analysis of open-ended responses indicated that attendees valued the training, especially in conflict resolution and teamwork, and indicated specific action plans for applying these skills. Furthermore, the workshop spurred some participants to express plans to learn more about leadership competencies.Conclusions: This study extends prior experience in offering an emotional intelligence-based leadership workshop for CRs. Though the program is novel, further research is needed to more fully understand the impact of leadership training for CRs and for the institutions and patients they serve. [ABSTRACT FROM AUTHOR]

Background: Medical student evaluations are essential for determining clerkship grades. Electronic evaluations have various advantages compared to paper evaluations, such as increased ease of collection, asynchronous reporting, and decreased likelihood of becoming lost.Objectives: To determine whether electronic medical student evaluations (EMSEs) provide more evaluations and content when compared to paper shift card evaluations.Methods: This before and after cohort study was conducted over a 2.5-year period at an academic hospital affiliated with a medical school and emergency medicine residency program. EMSEs replaced the paper shift evaluations that had previously been used halfway through the study period. A random sample of the free text comments on both paper and EMSEs were blindly judged by medical student clerkship directors for their helpfulness and usefulness. Logistic regression was used to test for any relationship between quality and quantity of words.Results: A total of 135 paper evaluations for 30 students and then 570 EMSEs for 62 students were collected. An average of 4.8 (standard deviation [SD] 3.2) evaluations were completed per student using the paper version compared to 9.0 (SD 3.8) evaluations completed per student electronically (p < 0.001). There was an average of 8.8 (SD 8.5) words of free text evaluation on paper evaluations when compared to 22.5 (SD 28.4) words for EMSEs (p < 0.001). A statistically significant (p < 0.02) association between quality of an evaluation and the word count existed.Conclusions: EMSEs that were integrated into the emergency department tracking system significantly increased the number of evaluations completed compared to paper evaluations. In addition, the EMSEs captured more "helpful/useful" information about the individual students as evidenced by the longer free text entries per evaluation. [ABSTRACT FROM AUTHOR]

Background:Implementing large-scale multi-site objective structured clinical examination (OSCEs) for national competency examination in a low resource country is challenging. Aims:To describe the first national OSCE for national competency examination of medical doctors in Indonesia and evaluate the reliability, validity, feasibility, acceptability, and educational impact. Methods:We collected electronically the OSCE scores from 49 out of 73 medical schools that participated to assess reliability and validity. We conducted electronic survey to examiners, examinees, SP trainers, and OSCE coordinators to assess feasibility, acceptability, and educational impact. Results:The Cronbach’s alpha coefficient across station was 0.79. There was strong correlation between rubric and global rating scores in each station (coefficient correlation ranges from 0.705 to 0.82). The content validity ratio was 0.97. The coefficient correlation between OSCE and MCQ was 0.335 (p = 0.00). All 49 medical schools were able to conduct OSCE simultaneously. Examiners, examinees, SP trainers, and OSCE coordinators had good perception regarding feasibility and acceptability of OSCE. Both examiners and examinees indicated good educational impact of OSCE application. The cutting score based on the borderline regression method was 61.96%. There were 67.39% of the examinees achieved similar or above the cutting score. Conclusion:With 12 stations 15 min each, the reliability coefficient across station is intermediate. Content validity is good. It is feasible and acceptable to implement large-scale multi-site OSCEs in Indonesia. Examiners and examinees perceive good educational impact on OSCE implementation. [ABSTRACT FROM PUBLISHER]

A test series usually consists of various versions of a test. Test-takers and consumers of tests expect all these versions to be at the same level of difficulty, but this is very difficult to achieve at the test design stage. In this article we suggest that the establishment of a norm for test results may be a practical solution to this problem. We illustrate how a norm can be established by investigating historical data from an Afrikaans test of Academic Literacy (TAG) and then proposing a formula to standardise results whenever a new version is written. This can easily be done by using a program such as Excel. This will enable test administrators to treat test-takers equally and fairly whenever decisions about them have to be taken. [ABSTRACT FROM AUTHOR]

In this article the results of a critical reflection on the analysis of 564 technology education lesson plans are discussed. The critical reflection draws on the responses of approximately 120 South African technology education teachers in a teaching practice workbook where they had to choose a project and base five lessons on the project. The analysis of the above mentioned lesson plans is done in such a way that the linking of learning activities and assessment activities to learning outcomes and assessment standards is highlighted. In general it can be concluded that, although the learning outcomes and assessment standards are readily available and specified clearly in the policy documents of the national department of education, the particular teachers find it difficult to translate theory into practice when converting what is specified in the policy documents to learning activities and assessment activities in their lesson plans. This implies that the instructional strategy for the particular technology education programme should be adapted to include a comprehensive section on how to integrate aspects mentioned in the policy documents of the national department of education into actual lesson plans. Although the outcomes of the critical reflection on the results of the analysis mentioned above are directed at improving and adapting an instructional strategy in a particular in-service technology education programme in South Africa some knowledge transfer to similar situations should be possible. [ABSTRACT FROM AUTHOR]

This paper draws on research funded by the Bedford Charity (Harpur Trust) in which the narrative writing of reluctant writers in 10 Lower Schools (pupils aged 5-9) was levelled using, firstly, the Assessment of Pupil Progress (APP) criteria used in English primary and secondary schools and, secondly, criteria devised by the researcher. The latter were specifically designed for the assessment of narrative writing, whereas the APP criteria are generic. Findings resonate with the contrasting paradigms critiqued in D'Arcy's paper on the teaching and assessment of writing (D'Arcy 1999). Evidence suggests that levels assigned to individual texts can vary between one assessment criteria and another. In many cases, pupils achieved higher levels against criteria designed to evaluate creativity and the ability to tell a story. Appropriate assessment criteria are critical not only to summative evaluations but also to the planning of future teaching and learning. However, it is suggested that the dominant assessment paradigm and concomitant approaches to the pedagogy of writing in England have been influenced by discourses over which teachers have had little control. However, the future for the teaching and assessment of writing necessitates a paradigmatic shift. A retrospective of D'Arcy's paper may provide teachers and academics with the impetus for change. [ABSTRACT FROM AUTHOR]

Background: Vietnam is one of the most populous countries in Southeast Asia, yet it displays an unsettling lack of doctors. Aims: Medical education is an important factor contributing to this issue, yet little is known about the system currently in place in Vietnam. Methods: Through an extensive literary search of medical schools' and Ministry of Health's data, we have examined the current medical education system in Vietnam. Results: At present, there are 12 medical universities, and the general curriculum at each university follows a national framework but tends to vary from university to university. Medical training lasts either 4 or 6 years, with competitive graduates attending residency programs following graduation. While examinations are required to graduate, the lack of a national licensing exam makes it difficult to ensure that a nation-wide standard of quality exists, both at the medical universities themselves as well as amongst the doctors graduating from them. Conclusions: The development and institution of a national exam would introduce a standard of training throughout Vietnam's medical education system. Further, a substantial portion of a doctor's education is in subjects that are loosely related to medicine. When looking forward it will be important to evaluate whether or not these non-medical subjects detract from the quality of medical training. [ABSTRACT FROM AUTHOR]

Background: Patient-centered care has been described as one approach to cultural competency education that could reduce racial and ethnic health disparities by preparing providers to deliver care that is respectful and responsive to the preferences of each patient. In order to evaluate the effectiveness of a curriculum in teaching patient-centered care (PCC) behaviors to medical students, we drew on the work of Kleinman, Eisenberg, and Good to develop a scale that could be embedded across cases in an objective structured clinical examination (OSCE).Objective: To compare the reliability, validity, and feasibility of an embedded patient-centered care scale with the use of a single culturally challenging case in measuring students' use of PCC behaviors as part of a comprehensive OSCE.Methods: A total of 322 students from two California medical schools participated in the OSCE as beginning seniors. Cronbach's alpha was used to assess the internal consistency of each approach. Construct validity was addressed by establishing convergent and divergent validity using the cultural challenge case total score and OSCE component scores. Feasibility assessment considered cost and training needs for the standardized patients (SPs).Results: Medical students demonstrated a moderate level of patient-centered skill (mean = 63%, SD = 11%). The PCC Scale demonstrated an acceptable level of internal consistency (alpha = 0.68) over the single case scale (alpha = 0.60). Both convergent and divergent validities were established through low to moderate correlation coefficients.Discussion: The insertion of PCC items across multiple cases in a comprehensive OSCE can provide a reliable estimate of students' use of PCC behaviors without incurring extra costs associated with implementing a special cross-cultural OSCE. This approach is particularly feasible when an OSCE is already part of the standard assessment of clinical skills. Reliability may be increased with an additional investment in SP training. [ABSTRACT FROM AUTHOR]

Background: Education about substance use (SU) disorders remains inadequate in medical training.Objective: To describe the Chief Resident Immersion Training (CRIT) program in addiction medicine and to evaluate its impact on chief resident (CR) physicians' substance use knowledge, skills, clinical practice, and teaching.Design: A controlled educational study of CRIT programs (2003, 2004, and 2005) for incoming CRs in generalist disciplines. Intervention CRs were trained to diagnose, manage, and teach about SU. The control CRs sought but did not receive the intervention.Participants: Eighty-six CR applicants to the CRIT program.Measurements: Baseline and 6-month questionnaires assessing substance use knowledge, skills, clinical practice, and teaching. Outcomes were compared within groups from baseline to follow-up and between groups at follow-up.Results: The intervention (n = 64) and control (n = 22) CRs were similar demographically. At 6-month follow-up, the intervention CRs reported a significant increase in SU knowledge, confidence, and preparedness to diagnose, manage, and teach and an increase in SU clinical and teaching practices compared to their baseline and control CRs.Conclusions: This intensive training for chief residents (CRs) improved knowledge, confidence, and preparedness to diagnose, manage, and teach about substance use (SU), affecting both the CRs' SU clinical and teaching practices. The CRIT program was an effective model for dissemination of SU knowledge and skills to educators in a key position to share this training with a broader audience of medical trainees. This model holds potential to address other high priority medical, yet under-addressed, content areas as well. [ABSTRACT FROM AUTHOR]

Background: Mini-CEX scores assess resident competence. Rater training might improve mini-CEX score interrater reliability, but evidence is lacking.Objective: Evaluate a rater training workshop using interrater reliability and accuracy.Design: Randomized trial (immediate versus delayed workshop) and single-group pre/post study (randomized groups combined).Setting: Academic medical center.Participants: Fifty-two internal medicine clinic preceptors (31 randomized and 21 additional workshop attendees).Intervention: The workshop included rater error training, performance dimension training, behavioral observation training, and frame of reference training using lecture, video, and facilitated discussion. Delayed group received no intervention until after posttest.Measurements: Mini-CEX ratings at baseline (just before workshop for workshop group), and four weeks later using videotaped resident-patient encounters; mini-CEX ratings of live resident-patient encounters one year preceding and one year following the workshop; rater confidence using mini-CEX.Results: Among 31 randomized participants, interrater reliabilities in the delayed group (baseline intraclass correlation coefficient [ICC] 0.43, follow-up 0.53) and workshop group (baseline 0.40, follow-up 0.43) were not significantly different (p = 0.19). Mean ratings were similar at baseline (delayed 4.9 [95% confidence interval 4.6-5.2], workshop 4.8 [4.5-5.1]) and follow-up (delayed 5.4 [5.0-5.7], workshop 5.3 [5.0-5.6]; p = 0.88 for interaction). For the entire cohort, rater confidence (1 = not confident, 6 = very confident) improved from mean (SD) 3.8 (1.4) to 4.4 (1.0), p = 0.018. Interrater reliability for ratings of live encounters (entire cohort) was higher after the workshop (ICC 0.34) than before (ICC 0.18) but the standard error of measurement was similar for both periods.Conclusions: Rater training did not improve interrater reliability or accuracy of mini-CEX scores.Clinical Trials Registration: clinicaltrials.gov identifier NCT00667940 [ABSTRACT FROM AUTHOR]

Background: The McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) is a series of five tasks with an objective scoring system. The purpose of this study was to estimate the interrater and test-retest reliability of the MISTELS metrics and to assess their internal consistency.Methods: To determine interrater reliability, two trained observers scored 10 subjects, either live or on tape. Test-retest reliability was assessed by having 12 subjects perform two tests, the second immediately following the first. Interrater and test-retest reliability were assessed using intraclass correlation coefficients. Internal consistency between tasks was estimated using Cronbach's alpha.Results: The interrater and test-retest reliabilities for the total scores were both excellent at 0.998 [95% confidence interval (CI), 0.985-1.00] and 0.892 (95% CI, 0.665-0.968), respectively. Cronbach's alpha for the first assessment of the test-retest was 0.86.Conclusions: The MISTELS metrics have excellent reliability, which exceeds the threshold level of 0.8 required for high-stakes evaluations. These findings support the use of MISTELS for evaluation in many different settings, including residency training programs. [ABSTRACT FROM AUTHOR]

Reports on the science for the assessment of surgical education and training. Criticisms against the Halsteadian method; "Lancet" editorial criticizing the quality of current surgical research; Application of research design.

Background: Education in basic laparoscopic skills training is performed ideally in an inanimate laboratory. Monitoring of basic skills progression, which is essential during this tranining, often may be difficult because of the resources and manpower. This study investigated the differences between self-reported and observed scores during basic laparoscopic exercises.Methods: First-and second-year medical students involved in practice sessions using the LTS 2000 box trainer were included in the study. All the students were allowed to practice four tasks: placing pegs with their dominant and nondominant hands, transferring pegs from one hand to another starting with the dominant and nondominant hands, cannulating a pipe cleaner into a plastic tube, and progressing from one end of a rope to the other. Each student recorded his or her times and errors for each task. After these practice sessions, each student underwent an observed session (OS), performing all of the tasks, and was graded by a surgeon involved in laparoscopic education. All the students were asked to record another practice session. The self-reported performances from the session immediately before the OS (pre-OS) and the session immediately after the OS (post-OS) were compared with the performance in the OS.Results: A total of 36 students were included in this study. The mean time and mean error were similar between all the sessions. Although the scores in the OS did slightly differ from the scores in the pre-OS and post-OS, post hoc analysis showed that there was no statistically significant difference between the OS score and either the pre-OS or the post-OS score for any of the laparoscopic exercises.Conclusions: No differences between observed scores and self-reported scores were noted. The use of self-reported scores may be a good method for monitoring performance during training in laparoscopic basic skills. The self-reporting of basic laparoscopic exercises may conserve resources. [ABSTRACT FROM AUTHOR]

The article describes the use of borderline regression for short-answer questions (SAQs) in written assignments for medical education. The authors goes on to discuss the scoring rubric used for the assessment as well as how borderline regression allowed educators to set criterion-referenced standards.

Background: Emergency medicine (EM) residency programs use nonstandardized criteria to create applicant rank lists. One implicit assumption is that predictive associations exist between an applicant's rank and their future performance as a resident. To date, these associations have not been sufficiently demonstrated.Objectives: We hypothesized that a strong positive correlation exists between the National Resident Match Program (NRMP) match-list applicant rank, the United States Medical Licensing Examination (USMLE) Step 1 and In-Training Examination (ITE) scores, and the graduating resident rank.Methods: A total of 286 residents from five EM programs over a 5-year period were studied. The applicant rank (AR) was derived from the applicant's relative rank list position on each programs' submitted NRMP rank list. The graduation rank (GR) was determined by a faculty consensus committee. GR was then correlated to AR using a Spearman's partial rank correlation. Additional correlations were sought with a ranking of the USMLE Step Score (UR) and the ITE Score (IR).Results: Combining data for all five programs, weak positive correlations existed between GR and AR, UR, and IR. The majority of correlations ranged between. When comparing GR and AR, there was a weak correlation of 0.13 (p = 0.03).Conclusion: Our study found only weak correlations between GR and AR, UR, and IR, suggesting that those variables may not be strong predictors of resident performance. This has important implications for EM programs considering the resources devoted to applicant evaluation and ranking. [ABSTRACT FROM AUTHOR]

The author discusses the important role of remediation and re-assessment in medical education. The author mentions the paper by G. Pell, R. Fuller, M. Matthew and T. Roberts which provides evidence that challenges the evidence about standard remediation and re-assessment practice. Meanwhile, the author states that educators have a duty to help students understand their strengths and weaknesses and to guide improvement.