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As medical schools have changed their curricula to address foundational and clinical sciences in a more integrated fashion, teaching methods such as concept mapping have been incorporated in small group learning settings. Methods that can assess students' ability to apply such integrated knowledge are not as developed, however. The purpose of this project was to assess the validity of scores on a focused version of concept maps called mechanistic case diagrams (MCDs), which are hypothesized to enhance existing tools for assessing integrated knowledge that supports clinical reasoning. The data were from the medical school graduating class of 2018 (N = 136 students). In 2014-2015 we implemented a total of 16 case diagrams in case analysis groups within the Mechanisms of Health and Disease (MOHD) strand of the pre-clinical curriculum. These cases were based on topics being taught during the lectures and small group sessions for MOHD. We created an overall score across all 16 cases for each student. We then correlated these scores with performance in the preclinical curriculum [as assessed by overall performance in MOHD integrated foundational basic science courses and overall performance in the Clinical and Professional Skills (CAPS) courses], and standardized licensing exam scores [United States Medical Licensing Exam (USMLE)] Step 1 (following core clerkships) and Step 2 Clinical Knowledge (at the beginning of the fourth year of medical school). MCD scores correlated with students' overall basic science scores (r = 0.46, p = 0.0002) and their overall performance in Clinical and Professional Skills courses (r = 0.49, p < 0.0001). In addition, they correlated significantly with standardized exam measures, including USMLE Step 1 (r = 0.33, p [less than or equal to] 0.0001), and USMLE Step 2 CK (r = 0.39, p < 0.0001). These results provide preliminary validity evidence that MCDs may be useful in identifying students who have difficulty in integrating foundational and clinical sciences.

Purpose: To examine the validity of using scores from a clinical evaluation form as an assessment of clinical competence. Method: Investigators collected a longitudinal clinical skills assessment database that included scores reflecting performance on standardized patient interactions, case-based learning performance, scores on multiple-choice clinical examinations, and preceptors' ratings of students during their clerkships. Pearson correlation coefficients and coefficients corrected for attenuation were calculated between the mean preceptor rating CEF score and the other measures collected during years one and two. Results: Estimates from an earlier across-clerkship generalizability study of the CEF demonstrated that a mean rating computed across 28 forms and four clerkships (the average measurement frequencies observed in this study), yielded an estimated G-coefficient of 0.62 (Kreiter and Ferguson, 2001). Reliabilities for the other measures ranged from 0.23 to 0.56. Nine of the twelve clinical skill measures correlated with the CEF. For those significantly correlated measures where reliabilities could be calculated, correlations corrected for attenuation ranged from 0.46 to 0.58. Conclusion: This study indicates that the skills measured by the CEF are related to other clinical performance measures and, conversely, that pre-clinical measures of skills that are believed to be important during clinical years are in fact predictors of preceptors' ratings of clinical performance later in medical school. In addition, the magnitude of the disattenuated coefficients suggests that ratings on the CEF are dependent on important aspects such as clinical knowledge. This study suggests that when averaged over a large number of observations, mean CEF scores demonstrate validity coefficients large enough to support their use as part of an evaluation of students' clinical performance.

Discusses the importance of assessing medical students' competence in prevention knowledge, skills, and attitudes. Provides general guidance for programs interested in evaluating their prevention instructional efforts, and gives specific examples of possible methods for evaluating prevention education. Stresses the need to tailor assessment methods to local institutional objectives. (Author/DB)

The purpose of this article is to describe the reasons people give for deciding to lose weight compared by weight history and gender The sample consisted of 162 Caucasian community volunteers. Data were obtained from an extensive open-ended interview that was analyzed using content analysis. Respondents were categorized into five groups, according to their success at weight loss: Successful, Always Normal Weight, Underweight, Clinically Successful, and Always Obese. The Clinically Successful and Always Obese were included in the category Unsuccessful Dieter Reasons given for entering a weight-loss regime included attractiveness or appearance, health, fear self-esteem issues, age, and competition. For the Successful Dieter attractiveness and health were the two major motivations. Men and women were similar in their reasons for entering a weight-loss program The issue of what makes a decision of sufficient importance to maintain weight loss remains unexplained. 'Centrality' is offered as a possible explanation., What are the reasons people give for going on a diet or beginning an exercise program to lose weight? Are the reasons different for successful as compared to unsuccessful weight [...]

A study of binge eating disorder (BED) and weight cycling in a community-based sample of successful and unsuccessful dieters using written questionnaires and follow-up phone interviews revealed the 6-month prevalence of BED to be 6% for successful dieters and 19% for unsuccessful dieters with lifetime prevalence of 13% and 15% respectively. Unsuccessful dieters were twice/thrice likely to apply a lack of control during an incidence of overeating, eat alone because they were embarrassed and to be annoyed with themselves for overeating.

Teenage boys in Iowa appear to continue using smokeless tobacco (ST) products despite developing oral lesions. Researchers surveyed 821 boys in 11th and 12th grade regarding their use of ST. About 52% of the 821 boys had used some form of ST at least once, 265 boys had used ST more than five times and 183 boys identified as the experienced group had used ST more than 20 times. Of the experienced group, 32% had experience an oral lesion at some time during ST use. Boys who had experienced lesions were more likely to recognize the harmful effects of ST and had tried to quit at least once. However, they were less likely to have avoided all tobacco use and were more pessimistic about their future ability to quit than boys without lesions. After finding a lesion, 35% stopped using ST for some time, 24% moved the ST to another location in their mouth, 17% did both and very few boys talked to adults or health personnel about the lesions.

To determine whether self-identified independent learners differed significantly from their colleagues regarding preferred learning methods or sources of information, this study assessed physicians who scheduled independent learning activities and physicians who attended a traditional refresher course. Both groups rated learning methods and information sources similarly. (Author/CH)