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The current study aimed to evaluate the appropriateness of the decisions made to order diagnostic imaging for emergency trauma patients. A retrospective audit of 642 clinical decisions for 370 non-consecutive trauma cases was conducted at a level 1 adult trauma centre. Radiographs and computed tomography investigations were compared for compliance with the American College of Radiology/European Society of Radiology (ACR/ESR) imaging guidelines. The non-compliant imaging orders were evaluated for the following medical officer ranks: Junior Medical Officer (JMO), Senior Resident Medical Officer (SRMO), Emergency Medicine Registrar (EMR) and Consultants/Career Medical Officer (CMO). The time of imaging order (day/evening or night shift), whether the imaging led to conservative or surgical patient management, and whether the imaging order decisions led to a change in the clinical management of the patient were also considered. Non-compliance with the ACR/ESR guidelines was low. At least half of non-compliant decisions made by each level of medical officer resulted in a change in patient management. In total, 11 (65%), 25 (53%), 12 (63%) and 11 (52%) of non-compliant imaging orders placed by JMOs, SRMOs, EMRs and Consultants, respectively, resulted in change of patient management. JMOs and SRMOs ordered a significantly higher proportion of non-compliant imaging studies for conservatively managed patients in comparison to surgically managed patients. This study highlighted that most non-compliant imaging orders benefited the patient.

Background Medical schools apply a range of selection methods to ensure that admitted students succeed in the program. In Australia, selection tools typically include measures of academic achievement (e.g. the Australian Tertiary Admission Rank – ATAR) and aptitude tests (e.g. the Undergraduate Medicine and Health Sciences Admissions Test – UMAT). These are most commonly used to determine which applicants are invited for additional selection processes, such as interviews. However, no previous study has examined the efficacy of the first part of the selection process. In particular, are compensatory or non-compensatory approaches more effective in evaluating the outcomes of cognitive and aptitude tests, and do they affect the demographics of students selected for interview? Methods This study utilised data from consecutive cohorts of mainstream domestic students who applied to enter the UNSW Medicine program between 2013 to 2018. A compensatory ranked selection model was compared with a non-compensatory ranked model. Initially, ATAR marks and UMAT scores for each applicant were ranked within each cohort. In the compensatory model, the mean of the ATAR and UMAT ranks were used to determine the outcome. In the non-compensatory model, the lowest rank of ATAR and UMAT determined the outcome for each applicant. The impact of each model on the gender and socioeconomic status of applicants selected to interview was evaluated across all cohorts. Results The non-compensatory ranked selection model resulted in substantially higher ATAR and UMAT thresholds for invitation to interview, with no significant effect on the socioeconomic status of the selected applicants. Conclusions These results are important, demonstrating that it is possible to raise the academic threshold for selection to medicine without having any negative impact on applicants from low socioeconomic backgrounds. Overall, the evidence gathered in this study suggests that a non-compensatory model is preferable for selecting applicants for medical student selection interview.

Rationale and Objectives Radiology education is suited to delivery via e-learning which may be used to fill gaps in knowledge and help prepare medical students for internship. There is limited evidence of effectiveness of adaptive tutorials, a form of e-learning in a senior medical student cohort. Materials and Methods A randomized mixed methods crossover trial was performed to assess effectiveness of adaptive tutorials on engagement and understanding of appropriate use and interpretation of basic imaging studies. Eighty-one volunteer medical students from years 5 and 6 of a 6-year program were randomly allocated to one of two groups. In the first phase of the trial on head CT, one group received access to adaptive tutorials and the other to peer-reviewed web-based resources. A cross over was performed and the second phase of the trial addressing chest CT commenced. Examination style assessments were completed at the end of each phase. At the trial's conclusion, an online questionnaire was provided to evaluate student perceptions of engagement and efficacy of each educational resource. Results Adaptive tutorial groups in both phases achieved higher mean scores than controls which were statistically significant in the first phase only. Students reported higher engagement and overall perceived value of the adaptive tutorials than controls. Conclusion Adaptive tutorials are overwhelmingly supported by senior medical students. Questionnaire responses suggest the engaging nature of the tutorials efficiently aids participation and knowledge retention which is in principle supported by test results.

INTRODUCTION: Narratives (as opposed to stories) can assess multiple facets of the same problem through the viewpoints of different characters. METHODS: Narratives related to three cancer patients, from diagnosis to cure or death, were used to teach seven cancer-related themes in a Cancer Pathology course offered to third-year medical science and science (college) undergraduates. RESULTS: The majority of students preferred narrative-based learning compared with traditional learning methods because they felt that it improved their learning experience and retention of information. CONCLUSION: Narrative-based learning may improve the learning experience of students by contextualizing complex concepts and highlighting real-world applications of knowledge.

Background The COVID-19 pandemic and the consequent social distancing measures caused unprecedented disruption for medical and healthcare education. This study examined medical teachers’ experience with emergency remote teaching during the pandemic and their acceptance of online teaching after the pandemic. Methods In this sequential mixed methods study, online surveys were disseminated to teachers (n = 139) at two Asia–Pacific medical schools to evaluate their experience with emergency remote teaching during the pandemic. Subsequently, in-depth interviews were conducted with teachers from both institutions (n = 13). Each interviewee was classified into an adopter category based on Rogers’ Diffusion of Innovations Theory. Interview transcripts were analyzed thematically, and the descriptive themes were mapped to broader themes partly based on the Technology Acceptance Model and these included: (i) perceived usefulness of online teaching, (ii) perceived ease of delivering online teaching, (iii) experience with institutional support and (iv) acceptance of online teaching after the pandemic. Results Our participants described accounts of successes with their emergency remote teaching and difficulties they experienced. In general, most participants found it difficult to deliver clinical skills teaching remotely and manage large groups of students in synchronous online classes. With regards to institutional support, teachers with lower technological literacy required just-in-time technical support, while teachers who were innovative in their online teaching practices found that IT support alone could not fully address their needs. It was also found that teachers’ acceptance of online teaching after the pandemic was influenced by their belief about the usefulness of online teaching. Conclusions This study demonstrated that our participants managed to adapt to emergency remote teaching during this pandemic, and it also identified a myriad of drivers and blockers to online teaching adoption for medical teachers. It highlights the need for institutes to better support their teaching staff with diverse needs in their online teaching.

Concept and knowledge maps have been shown to improve students’ learning by emphasising meaningful relationships between phenomena. A user-friendly online tool that enables assessment of students’ maps with automated feedback might therefore have significant benefits for learning. For that purpose, we developed an online software platform known as Knowledge Maps. Two pilot studies were performed to evaluate the usability and efficacy of Knowledge Maps. Study A demonstrated significantly improved perceptions of learning after using Knowledge Maps to learn pathology. Study B showed significant improvement between pre-test and post-test scores in an anatomy course. These preliminary studies indicate that this software is readily accepted and may have potential benefits for learning.

Background: Modern clinical practice increasingly relies on collaborative and team-based approaches to care. Regulatory bodies in medical education emphasise the need to develop collaborative and teamwork competencies and highlight the need to do so from an early stage of medical training. During undergraduate medical education the focus is usually to facilitate collaborative learning and increase feedback and reflection on this learning. This article describes a novel educational instrument, the Collaborative Learning Development Exercise (CLeD-EX), which aims to foster the development of key collaborative learning competencies in medical students. Methods: In this study, the “educational design research” framework was used to develop, implement and evaluate the CLeD-EX. This involved adopting a systematic approach towards designing a creative and innovative instrument which would help solve a real-world challenge in developing collaborative learning skills. The systematic approach involved a qualitative exploration of key collaborative learning behaviours which are influential in effective collaborative learning contexts. The identified competencies were employed in the design of the CLeD-EX. The design of the CLeD-EX included features to facilitate structured feedback by tutors to students, complemented by self-evaluation and reflection. The CLeD-EX was field-tested with volunteer junior medical students, using a controlled pre-test post-test design. Analysis of the completed CLeD-EX forms, self-perception surveys (i.e. pre-test and post-test surveys) and analyses of reflective reports were used to explore the educational impact of CLeD-EX, as well as its utility and practicality. Results: After using the CLeD-EX, students showed a significant improvement in self‑directed learning, critical thinking and group process as measured by a previously validated instrument. Both students and tutors recognised CLeD-EX as an effective instrument, especially as a structured basis for giving and receiving feedback and for completing the feedback loop. CLeD-EX was also found to be feasible, practical and focused, while promoting learning and effective interactions in small group learning. Conclusion: The findings of this study support the introduction of an educational instrument such as the CLeD-EX to facilitate the development of students’ skills in collaborative learning.

Background There is an ongoing debate about the impact of studying medicine in rural vs. metropolitan campuses on student assessment outcomes. The UNSW Medicine Rural Clinical School has five main campuses; Albury-Wodonga, Coffs Harbour, Griffith, Port Macquarie and Wagga Wagga. Historical data of student assessment outcomes at these campuses raised concerns regarding potential biases in assessment undertaken, as well as the availability and quality of learning resources. The current study aims to identify the extent to which the location of examination (rural versus metropolitan) has an impact on student marks in OSCEs. Methods Assessment data was employed for this study from 275 medical students who sat their final examinations in Years 3 and 6 of the undergraduate Medicine program at UNSW in 2018. The data consists of matched student assessment results from the Year 3 (Y3) MCQ examination and OSCE, and from the Year 6 (Y6) MCQ, OSCE and management viva examinations. The analysis used Univariate Analysis of Variance and linear regression models to identify the impact of site of learning and site of examination on assessment outcomes. Results The results demonstrate that neither site of learning nor site of examination had any significant impact on OSCE or Management Viva assessment outcomes while potential confounders are controlled. Conclusion It is suggested that some of the supposed disadvantages inherent at rural campuses are effectively mitigated by perceived advantages; more intensive interaction with patients, the general and medical communities at those sites, as well as effective e-learning resources and moderation of assessment grades.

Background Most assessments in health professions education consist of knowledge-based examinations as well as practical and clinical examinations. Among the most challenging aspects of clinical assessments is decision making related to borderline grades assigned by examiners. Borderline grades are commonly used by examiners when they do not have sufficient information to make clear pass/fail decisions. The interpretation of these borderline grades is rarely discussed in the literature. This study reports the application of the Objective Borderline Method (version 2, henceforth: OBM2) to a high stakes Objective Structured Clinical Examination undertaken at the end of the final year of a Medicine program in Australia. Methods The OBM2 uses all examination data to reclassify borderline grades as either pass or fail. Factor analysis was used to estimate the suitability of data for application of OBM2. Student’s t-tests, utilising bootstrapping, were used to compare the OBM2 with ‘traditional’ results. Interclass correlations were used to estimate the association between the grade reclassification and all other grades in this examination. Results The correlations between scores for each station and pass/fail outcomes increased significantly after the mark reclassification, yet the reclassification did not significantly impact on students’ total scores. Examiners, students and program leaders expressed high levels of satisfaction and the Faculty’s Curriculum Development Committee has decided that the OBM2 will be used for all future clinical examinations. Implications of the OBM2 are discussed. Conclusions The OBM2 provides a feasible, defensible and acceptable solution for classification of borderline grades as either pass or fail.

Background Although blended learning has the potential to enhance the student experience, both in terms of engagement and flexibility, it can be difficult to effectively restructure existing courses. To achieve these goals for an introductory Pathology course, offered to more than 250 undergraduate students at UNSW Sydney, we devised a novel approach. Methods For each topic presented over 2–3 weeks, a single face-to-face overview lecture was retained. The remaining content that had previously been delivered as conventional lectures was converted into short (12–18 min) online modules. These were based on lecture slides with added animations/highlights, plus narration using edited excerpts of previous lecture recordings. The modules also incorporated interactive questions and review quizzes with feedback which used various question types. Modules were developed in PowerPoint and iSpring and uploaded to Moodle as SCORM packages. Each topic concluded with an interactive large-group session focussing on integration of the content, with in-class questions to which students could respond via the Echo360 Active Learning Platform (ALP). Overall, more than 50% of face-to-face lecture time was replaced by online modules and interactive large-group sessions. Quantitative evaluation data included usage statistics from 264 students and feedback via online survey responses from 41 students. Qualitative evaluation data consisted of reflective commentaries from 160 student ePortfolios, which were analysed to identify factors affecting learning benefits and user acceptability. Results All of the modules were completed by 74% of students and on average, 83.1% of students eventually passed the optional review quizzes. Notably, 88.4% of students responded to in-class questions during the integration and feedback sessions via the ALP. Student reflections emphasised that the modules promoted understanding, which was reinforced through active learning. The modules were described as enjoyable, motivating and were appreciated for their flexibility, which enabled students to work at their own pace. Conclusions In transforming this introductory Pathology course, we have demonstrated a model for the use of blended learning in large group teaching sessions, which achieved high levels of completion, satisfaction and value for learning. Electronic supplementary material The online version of this article (10.1186/s12909-017-1057-2) contains supplementary material, which is available to authorized users.

To determine whether cytopathology whole slide images and virtual microscopy adaptive tutorials aid learning by postgraduate trainees, we designed a randomized crossover trial to evaluate the quantitative and qualitative impact of whole slide images and virtual microscopy adaptive tutorials compared with traditional glass slide and textbook methods of learning cytopathology. Forty-three anatomical pathology registrars were recruited from Australia, New Zealand, and Malaysia. Online assessments were used to determine efficacy, whereas user experience and perceptions of efficiency were evaluated using online Likert scales and open-ended questions. Outcomes of online assessments indicated that, with respect to performance, learning with whole slide images and virtual microscopy adaptive tutorials was equivalent to using traditional methods. High-impact learning, efficiency, and equity of learning from virtual microscopy adaptive tutorials were strong themes identified in open-ended responses. Participants raised concern about the lack of z-axis capability in the cytopathology whole slide images, suggesting that delivery of z-stacked whole slide images online may be important for future educational development. In this trial, learning cytopathology with whole slide images and virtual microscopy adaptive tutorials was found to be as effective as and perceived as more efficient than learning from glass slides and textbooks. The use of whole slide images and virtual microscopy adaptive tutorials has the potential to provide equitable access to effective learning from teaching material of consistently high quality. It also has broader implications for continuing professional development and maintenance of competence and quality assurance in specialist practice.

This article was migrated. The article was not marked as recommended. With the increasing complexity of healthcare delivery and patient case mix, and the aging population, health professionals are expected to function more often and more effectively as members of multidisciplinary teams. Competency based medical education (CBME) advocates that the professional development of doctors should be fostered from the start of medical school through to medical practice and with continuing professional development. Strategies for developing teamwork among health professionals and students range from minimal, implicit to explicit (Earnest et al., 2017). Considering this continuum of medical education and the spectrum of educational strategies, we propose a framework for the programmatic approach which can be used in developing competence in 'collaborative clinical practice'.

Online formative assessments have become increasingly popular; however, formal evidence supporting their educational benefits is limited. This study investigated the impact of online feedback quizzes on the learning experiences and outcomes of undergraduate students enrolled in an introductory physiology course. Four quiz models were tested, which differed in the amount of credit available, the number of attempts permitted, and whether the quizzes were invigilated or unsupervised, timed or untimed, or open or closed book. All quizzes were composed of multiple-choice questions and provided immediate individualized feedback. Summative end-of-course examination marks were analyzed with respect to performance in quizzes and were also compared with examination performance in the year before the quizzes were introduced. Online surveys were conducted to gather students' perceptions regarding the quizzes. The vast majority of students perceived online quizzes as a valuable learning tool. For all quiz models tested, there was a significant relationship between performance in quizzes and end-of-course examination scores. Importantly, students who performed poorly in quizzes were more likely to fail the examination, suggesting that formative online quizzes may be a useful tool to identify students in need of assistance. Of the four quiz models, only one quiz model was associated with a significant increase in mean examination performance. This model had the strongest formative focus, allowing multiple unsupervised and untimed attempts. This study suggests that the format of online formative assessments is critical in achieving the desired impact on student learning. Specifically, such assessments are most effective when they are low stakes.

Student interest in botany and enrolment in plant sciences courses tends to be low compared to that in other biological disciplines. One potential way of increasing student interest in botany is to focus on course material designed to raise student enthusiasm and satisfaction. Here, we introduce and evaluate virtual microscopy in botany teaching. Virtual microscopy uses high-resolution digital ‘virtual slides’ that allow students to explore microscope sections without the advanced skills required to prepare glass slides. Questionnaire feedback from students indicated that students found the virtual slides an effective learning tool. Further, we found that student performance in assessments was significantly higher when using virtual slides than when using traditional glass slides. We suggest that virtual slides are an effective tool for increasing student satisfaction in introductory botany courses, and have the potential for increasing student enrolment in higher-level courses (honours) and research degrees.

Portfolios are an established method of assessment, although concerns do exist around their validity for capabilities such as reflection and self‐direction. This article describes an e‐portfolio which closely aligns learning and reflection to graduate capabilities, incorporating features that address concerns about portfolios. Students are required to complete assessments linked to graduate capabilities. In Year 3, a portfolio review occurs (205–248 students per year), focusing on students' grades and feedback from assessments and a reflective essay is submitted. In the essay, students reflect on their progress, identify areas of weakness and detail plans for improvement. Progress in each capability is summatively graded against specific criteria and feedback is provided. Students progressively accumulate evidence of learning linked to the graduate capabilities. The provision of sufficient structure prevents evasion of areas of weakness. Importantly, the equal weighting given to all graduate capabilities ...

Introduction: Medical education has transitioned to require more active student learning, including self-directed and collaborative approaches. Although there are many advantages to collaborative small-group environments, learning in this setting is not always effective. One potential factor is that behaviours that are key to the success of small-group collaborative learning in medical education are yet to be clearly defined. In this study, we aimed to identify and prioritise behaviours that are relevant to individual students effective collaborative learning in small groups. Method: A two-round modified-Delphi approach was used to identify student behaviours that positively influenced the success of small-group collaborative-learning environments. In Round 1, the panel members were asked to rate the impact of 15 student behaviours on two subscales: (1) enhancing the quality of learning and (2) fostering a collaborative environment. The top 10 behaviours identified were utilised for Round 2, in which the panel members were asked to rank the behaviours based on the magnitude of their positive impact on students’ quality of learning. Results: Collaborative group behaviours were prioritised in Round 2, and the top six behaviours were selected for the design of a user-friendly educational intervention for medical students. The key behaviours identified were preparation by the student, involvement in discussion, engagement in learning, listening skills, sharing views and voicing opinions, reflecting on feedback and responding appropriately. Conclusions: This study identified six key behaviours that influence students’ learning in small-group collaborative-learning environments. These findings will inform further research at our institution into the development and evaluation of an educational intervention that aims to foster the identified behaviours in medical students.

In higher education, most assessments or examinations comprise either multiple-choice items or open-ended questions such as modified essay questions (MEQs). Online concept and knowledge maps are potential tools for assessment, which might emphasize meaningful, integrated understanding of phenomena. We developed an online knowledge-mapping assessment tool, which provides automated feedback on student-submitted maps. We conducted a pilot study to investigate the potential utility of online knowledge mapping as a tool for automated assessment by comparing the scores generated by the software with manual grading of a MEQ on the same topic for a cohort of first-year medical students. In addition, an online questionnaire was used to gather students’ perceptions of the tool. Map items were highly discriminating between students of differing knowledge of the topic overall. Regression analysis showed a significant correlation between map scores and MEQ scores, and responses to the questionnaire regarding use of knowledge maps for assessment were overwhelmingly positive. These results suggest that knowledge maps provide a similar indication of students’ understanding of a topic as a MEQ, with the advantage of instant, consistent computer grading and time savings for educators. Online concept and knowledge maps could be a useful addition to the assessment repertoire in higher education.

Students in the six-year undergraduate medicine program at UNSW must submit a portfolio which demonstrates inter alia their development in teamwork skills. Much of the feedback they need to develop these skills, as well as the evidence they require to document their achievements, can only come from their peers. The eMed Teamwork system, developed for this purpose, is a computer-based system which gathers feedback from peers in project groups. The feedback submitted to the system is available to the recipient for formative purposes, and becomes part of both the author's and the recipient's portfolios for later summative assessment. This dual use ensures that the feedback is thoughtful and constructive and the system operates without significant moderation by teachers.

Purpose Health care expenditure on diagnostic imaging investigations is increasing, and many tests are ordered inappropriately. Validated clinical decision rules (CDRs) for certain conditions are available to aid in assessing the need for imaging. However, awareness and utilization of CDRs are lacking. This study compared the efficacy and perceived impact of interactive e-learning modules versus static versions of CDRs, for learning about appropriate imaging referrals. Methods A multicenter, randomized, crossover trial was performed; participants were volunteer medical students and recent graduates. In week 1, group 1 received an e-learning module on appropriate imaging referrals for pulmonary embolism; group 2 received PDF versions of relevant CDRs, and an online quiz with feedback. In week 2, the groups crossed over, focusing on imaging referrals for cervical spine trauma in adults. Online assessments were administered to both groups at the end of each week, and participants completed an online questionnaire at the end of the trial. Results Group 1 (e-learning module) performed significantly better on the pulmonary embolism knowledge assessment. After the crossover, participants in group 2 (e-learning module) were significantly more likely to improve their scores in the assessment of cervical spine trauma knowledge. Both groups gave positive evaluations of the e-learning modules. Conclusions Interactive e-learning was significantly more effective for learning in this cohort, compared with static CDRs. We believe that the authentic clinical scenarios, feedback, and integration provided by the e-learning modules contributed to their impact. This study has implications for implementation of e-learning tools to facilitate appropriate referrals for imaging investigations in clinical practice.

Rationale and Objectives Diagnostic imaging is under-represented in medical curricula globally. Adaptive tutorials, online intelligent tutoring systems that provide a personalized learning experience, have the potential to bridge this gap. However, there is limited evidence of their effectiveness for learning about diagnostic imaging. Materials and Methods We performed a randomized mixed methods crossover trial to determine the impact of adaptive tutorials on perceived engagement and understanding of the appropriate use and interpretation of common diagnostic imaging investigations. Although concurrently engaged in disparate blocks of study, 99 volunteer medical students (from years 1–4 of the 6-year program) were randomly allocated to one of two groups. In the first arm of the trial on chest X-rays, one group received access to an adaptive tutorial, whereas the other received links to an existing peer-reviewed Web resource. These two groups crossed over in the second arm of the trial, which focused on computed tomography scans of the head, chest, and abdomen. At the conclusion of each arm of the trial, both groups completed an examination-style assessment, comprising questions both related and unrelated to the topics covered by the relevant adaptive tutorial. Online questionnaires were used to evaluate student perceptions of both learning resources. Results In both arms of the trial, the group using adaptive tutorials obtained significantly higher assessment scores than controls. This was because of higher assessment scores by senior students in the adaptive tutorial group when answering questions related to topics covered in those tutorials. Furthermore, students indicated significantly better engagement with adaptive tutorials than the Web resource and rated the tutorials as a significantly more valuable tool for learning. Conclusions Medical students overwhelmingly accept adaptive tutorials for diagnostic imaging. The tutorials significantly improve the understanding of diagnostic imaging by senior students.

Virtual slides are high-magnification digital images of tissue sections, stored in a multi-resolution file format. Using appropriate software, these slides can be viewed in a web browser in a manner that closely simulates examination of glass slides with a real microscope. We describe the successful implementation of teaching microscopic pathology with virtual slides and, for the first time, their use in summative assessment. Both students and teaching staff readily adapted to the use of virtual microscopy. Questionnaire feedback from students strongly indicated that virtual slides solved a number of problems in their learning, while providing good to excellent image quality. A deliberate policy of allocating two students per workstation promoted collaboration and helped to maintain interest in microscopic pathology. The use of a secure browser facilitated assessment using virtual slides, with no technical or security issues arising despite high peak demand. The new Medicine programme at the University of New South Wales will exclusively utilize virtual microscopy for the study of both histology and histopathology. We believe that the use of high-quality learning resources such as virtual slides can ensure that microscopic examination of tissues remains both meaningful and interesting.

An interactive computer-assisted learning (CAL) module on glomerulonephritis, previously identified by fourth-year medical students as a difficult topic, was developed. The module comprised background material, case studies, graphics, animation, video and supporting quizzes with feedback. The impact of the module on student learning was evaluated by comparing the performance of two matched groups of students, only one of which accessed the CAL module, in an online assessment. The analysis examined the effect of having completed a clinical term in renal medicine. A significant improvement in the performance of those students who used the CAL module was demonstrated. Unexpectedly, completing a renal medicine term had no beneficial influence on students' performance. Students who used the CAL module perceived a significant decrease in the difficulty of the topic. It is concluded that the module is an effective learning tool, but important caveats are noted associated with using CAL modules in redesigned medical curricula.

Background: This paper is an evaluation of an integrated selection process utilising previous academic achievement [Universities Admission Index (UAI)], a skills test [Undergraduate Medicine and Health Sciences Admission Test (UMAT)], and a structured interview, introduced (in its entirety) in 2004 as part of curriculum reform of the undergraduate Medicine Program at the University of New South Wales (UNSW), Australia. Demographic measures of gender, country of birth, educational background and rurality are considered. Method: Admission scores and program outcomes of 318 students enrolled in 2004 and 2005 were studied. Regression analyses were undertaken to determine whether selection scores predicted overall, knowledge-based and clinical-based learning outcomes after controlling for demographics. Results: UAI attained the highest values in predicting overall and knowledge-based outcomes. The communication dimension of the interview achieved similar predictive values as UAI for clinical-based outcomes, although predictive values were relatively low. The UMAT did not predict any performance outcome. Female gender, European/ European-derived country of birth and non-rurality were significant predictors independent of UAI scores. Conclusion: Results indicate promising validity for an integrated selection process introduced for the Medicine Program at UNSW, with UAI and interview predictive of learning outcomes. Although not predictive, UMAT may have other useful roles in an integrated selection process. Further longitudinal research is proposed to monitor and improve the validity of the integrated student selection process.

Context Concept maps have been used to promote meaningful learning and critical thinking. Although these are crucially important in all disciplines, evidence for the benefits of concept mapping for learning in medicine is limited. Methods We performed a randomised crossover study to assess the benefits of online testable concept maps for learning in pathology by volunteer junior medical students. Participants (n = 65) were randomly allocated to either of two groups with equivalent mean prior academic performance, in which they were given access to either online maps or existing online resources for a 2-week block on renal disease. Groups then crossed over for a 2-week block on hepatic disease. Outcomes were assessed using timed online quizzes, which included questions unrelated to topics in the pathogenesis maps as an internal control. Questionnaires were administered to evaluate students' acceptance of the maps. Results In both blocks, the group with access to pathogenesis maps achieved significantly higher average scores than the control group on quiz questions related to topics covered by the maps (Block 1: p

Background: Concept maps are widely used in education to promote meaningful learning, critical thinking and problem-solving skills. Such maps are of particular interest within medical education because concept mapping is a form of active learning, which can foster the life-long learning medical students require to manage an ever- increasing body of knowledge. Issues: Despite these benefits, the introduction of concept maps in curricula can often be met with resistance. To overcome this obstacle, providing varying levels of guidance, i.e., scaffolded versus self-constructed concept maps, may be more suited to novice and experienced students, respectively. Furthermore, immediate feedback (known to enhance student learning and motivation) is difficult and time-consuming to provide. Conclusions: As such, future research into concept mapping would benefit from the development and validation of automated tools for their assessment. Although concept maps are effectively utilised within limited contexts in medical education, consideration of how they can be most effectively employed is needed.

Background e-learning resources may be beneficial for complex or conceptually difficult topics. Leukaemia is one such topic, yet there are no reports on the efficacy of e-learning for leukaemia. This study compared the learning impact on senior medical students of a purpose-built e-learning module on leukaemia, compared with existing online resources. Methods A randomised controlled trial was performed utilising volunteer senior medical students. Participants were randomly allocated to Study and Control groups. Following a pre-test on leukaemia administered to both groups, the Study group was provided with access to the new e-learning module, while the Control group was directed to existing online resources. A post-test and an evaluation questionnaire were administered to both groups at the end of the trial period. Results Study and Control groups were equivalent in gender distribution, mean academic ability, pre-test performance and time studying leukaemia during the trial. The Study group performed significantly better than the Control group in the post-test, in which the group to which the students had been allocated was the only significant predictor of performance. The Study group’s evaluation of the module was overwhelmingly positive. Conclusions A targeted e-learning module on leukaemia had a significant effect on learning in this cohort, compared with existing online resources. We believe that the interactivity, dialogic feedback and integration with the curriculum offered by the e-learning module contributed to its impact. This has implications for e-learning design in medicine and other disciplines.

Concept maps can assist learning by integrating new information with existing cognitive structure to facilitate meaningful understanding. The benefits of testable concept maps to illustrate cause-and-effect sequences in the pathogenesis of disease have not yet been determined.A controlled trial was employed to evaluate the learning benefits of testable pathogenesis maps.Consecutive cohorts of junior medical students allocated to control and study groups participated in case-based pathology practical classes. Online testable pathogenesis maps were integrated into classes for the study group. An online quiz and questionnaire were used to evaluate outcomes.The study group scored significantly higher on the quiz (p= .014), including significantly better performance in topics covered by pathogenesis maps (p= .049). The study group's questionnaire responses regarding pathogenesis maps were overwhelmingly positive.Testable pathogenesis maps significantly improved medical students' understanding of the pathogenesis of disease. Wider use of such maps should be explored.

A key factor in the successful involvement of teachers in the development of intelligent tutoring systems (ITS) is a development paradigm that accommodates teachers' skills and goals In this paradigm, a mental model that is meaningful from the teacher's perspective must be created for each task We have focused on supporting teachers throughout the process of developing, deploying and analyzing Adaptive Tutorials that use Virtual Slides (ATuVS), which were created to assist learning of microscopic morphology This was facilitated by the Virtual Apparatus Framework (VAF) – an ITS architecture that enables development of online learning activities analogous to real-world laboratory activities VAF allows us to develop authoring tools that follow a well-established pedagogical process, which teachers can easily work with In order to evaluate the effectiveness of VAF as a teacher-oriented design paradigm, we introduce the concept of “pedagogical ownership” We argue that mainstream adoption of ITS in general, and ATuVS in particular, is only possible if teachers can assert pedagogical ownership over them.

Background: The constant growth in the body of knowledge in medicine requires pathologists and pathology trainees to engage in continuing education. Providing them with equitable access to efficient and effective forms of education in pathology (especially in remote and rural settings) is important, but challenging. Methods: We developed three pilot cytopathology virtual microscopy adaptive tutorials (VMATs) to explore a novel adaptive E-learning platform (AeLP) which can incorporate whole slide images for pathology education. We collected user feedback to further develop this educational material and to subsequently deploy randomized trials in both pathology specialist trainee and also medical student cohorts. Cytopathology whole slide images were first acquired then novel VMATs teaching cytopathology were created using the AeLP, an intelligent tutoring system developed by Smart Sparrow. The pilot was run for Australian pathologists and trainees through the education section of Royal College of Pathologists of Australasia website over a period of 9 months. Feedback on the usability, impact on learning and any technical issues was obtained using 5-point Likert scale items and open-ended feedback in online questionnaires. Results: A total of 181 pathologists and pathology trainees anonymously attempted the three adaptive tutorials, a smaller proportion of whom went on to provide feedback at the end of each tutorial. VMATs were perceived as effective and efficient E-learning tools for pathology education. User feedback was positive. There were no significant technical issues. Conclusion: During this pilot, the user feedback on the educational content and interface and the lack of technical issues were helpful. Large scale trials of similar online cytopathology adaptive tutorials were planned for the future.

The new medicine program at the University of New South Wales employs scenario-based learning with vertically integrated classes of year 1 and year 2 students, as well as horizontally integrated teaching with no discipline-specific courses. Coinciding with its introduction, we undertook comprehensive revision of the approach to teaching microscopic anatomy and pathology. We designed practical classes around virtual slides, which are high-magnification digital images of tissue sections stored in a multiresolution file format, viewable in a Web browser in a manner closely simulating conventional microscopy. In these classes, we integrated the teaching of histology and histopathology, introducing students to the microscopic features of tissues and organs, and giving them the opportunity to compare and contrast the normal with the abnormal in various disease states. Members of academic staff from both anatomy and pathology were present to promote discussion and respond to questions. Worksheets defined learning objectives and provided clinical cases as contexts for learning in each class. Evaluation revealed that students strongly supported the integrated approach. The efficiency of the teaching method meant that it was possible to work through 5-8 virtual slides per 2-hr class without difficulty. Students displayed considerable initiative in exploring the histological features of tissues, identifying the changes in various pathological states, and recognizing their relationship to clinical manifestations. We believe that the approach we have developed should help to minimize the potential adverse impact of curriculum reform on the teaching of morphology, while ensuring that learning remains both meaningful and interesting.

Formative assessment with appropriate feedback is an effective method of promoting learning. Software tools are now available to facilitate the delivery of formative self-assessments via the World Wide Web. For the past 5 years, we have offered on-line formative self-assessments in pathology to undergraduate medical students. These assessments, which have been authored using Questionmark Perception, have proved particularly popular and have received high ratings in course evaluation surveys. Furthermore, they appear to have been effective in promoting student learning, with evidence that students made a genuine attempt to answer the questions in the assessment and that they learnt from doing so. The potential of on-line formative self-assessments for postgraduate training and continuing education in pathology so far remains untapped.

We investigated whether development of pulmonary fibrosis following inhalational exposure of mice to silica (quartz) dust was accompanied by enhanced secretion of activity resembling epidermal growth factor (EGF). Mitogenic activity for pulmonary fibroblasts was assessed in bronchoalveolar lavage fluid (BALF) using a serum-free bioassay. Activity in BALF from mice exposed to nonfibrogenic titanium dioxide dust was comparable to that in BALF from normal animals. In contrast, mitogenic activity was significantly increased at 6 and 12 weeks after inhalation of silica particles, coinciding with the appearance of collagenised lesions in the lung. BALF from mice exposed to silica 6 weeks previously had significantly higher concentrations of growth factor(s) able to bind to EGF receptors on pulmonary fibroblasts. In parallel, macrophages within inflammatory lesions in the airspaces acquired immunoreactivity for EGF. The presence of an increased concentration of EGF-like growth factor(s) in BALF might constitute a marker of particle-induced pulmonary fibrosis.

Summary To evaluate components of the pulmonary cellular response to inhaled silica that might be determinants of progression to fibrosis, we developed a model of the early stages of chronic human silicosis. Groups of mice were subacutely exposed either to α-quartz or to nonfibrogenic titanium dioxide dust as a control. Induction of lesions by inhaled silica was dependent upon the size distribution and dose of the particles. A novel observation was that low intensity exposure to silica evoked reversible inflammatory lesions that were characterized by focal aggregation of particle-laden alveolar macrophages near terminal airways. In contrast, higher intensity exposure elicited progressive pulmonary inflammation, including a significant perivascular influx of T-lymphocytes early in the response. The airspace inflammatory lesions exhibited a statistically significant decline in numerical density over time. Meanwhile, deposition of collagen was observed at perivascular locations, which were anatomically distinct from the initial foci of inflammation, and the numerical density of fibrotic lesions increased significantly with time. We speculate that this pattern of response might be related to alveolar clearance mechanisms being overwhelmed, followed by trans-location and sequestration of particles in the interstitium, subsequently leading to T-lymphocyte recruitment and ultimately to the development of fibrosis.

Background Online formative assessments have a sound theoretical basis, and are prevalent and popular in higher education settings, but data to establish their educational benefits are lacking. This study attempts to determine whether participation and performance in integrated online formative assessments in the biomedical sciences has measurable effects on learning by junior medical students. Methods Students enrolled in Phase 1 (Years 1 and 2) of an undergraduate Medicine program were studied over two consecutive years, 2006 and 2007. In seven consecutive courses, end-of-course (EOC) summative examination marks were analysed with respect to the effect of participation and performance in voluntary online formative assessments. Online evaluation surveys were utilized to gather students' perceptions regarding online formative assessments. Results Students rated online assessments highly on all measures. Participation in formative assessments had a statistically significant positive relationship with EOC marks in all courses. The mean difference in EOC marks for those who participated in formative assessments ranged from 6.3% (95% confidence intervals 1.6 to 11.0; p = 0.009) in Course 5 to 3.2% (0.2 to 6.2; p = 0.037) in Course 2. For all courses, performance in formative assessments correlated significantly with EOC marks (p < 0.001 for each course). The variance in EOC marks that could be explained by performance in the formative assessments ranged from 21.8% in Course 6 to 4.1% in Course 7. Conclusion The results support the contention that well designed formative assessments can have significant positive effects on learning. There is untapped potential for use of formative assessments to assist learning by medical students and postgraduate medical trainees.