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Introduction: Using assessment to facilitate learning is a well-established priority in education but has been associated with variable effectiveness for continuing professional development. What factors modulate the impact of testing in practitioners are unclear. We aimed to improve capacity to support maintenance of competence by exploring variables that influence the value of web-based pretesting., Methods: Family physicians belonging to a practice-based learning program studied two educational modules independently or in small groups. Before learning sessions they completed a needs assessment and were assigned to either sit a pretest intervention or read a relevant review article. After the learning session, they completed an outcome test, indicated plans to change practice, and subsequently documented changes made., Results: One hundred twelve physicians completed the study, 92 in small groups. The average lag between tests was 6.3 weeks. Relative to those given a review article, physicians given a pretest intervention: (1) reported spending less time completing the assigned task (16.7 versus 25.7 minutes); (2) performed better on outcome test questions that were repeated from the pretest (65.9% versus 58.7%); and (3) when the learning module was completed independently, reported making a greater proportion of practice changes to which they committed (80.0% versus 45.0%). Knowledge gain was unrelated to physicians' stated needs., Discussion: Low-stakes formative quizzes, delivered with feedback, can influence the amount of material practicing physicians remember from an educational intervention independent of perceptions regarding the need to engage in continuing professional development on the particular topic.

Introduction: To better elucidate the impact of cooperative learning outside the classroom, a student-initiated research project was conducted to explore the effects of participating in peer-led study groups (PLSGs) on student examination scores and perceptions., Methods: First-year pharmacy students were given the opportunity to participate in weekly PLSGs for a pharmacogenomics course during spring 2016 and spring 2017. Student exam performance was stratified by those who attended vs. those who did not. Optional pre- and post-course surveys examined student perceptions of PLSGs., Results: No significant differences were seen between the attendance groups in spring 2016. In spring 2017, student attendees were significantly more likely to pass two of their six exams (p = .04, p = .0029) and to have higher exam scores on one exam (p = .02) in comparison to non-attendees. Overall exam score averages were significantly different between attendees and non-attendees during spring 2017 (p = .03) but not during spring 2016 (p = .38). Perception surveys indicated students believed participation helped them to demonstrate competency and build confidence. Additionally, students reported they felt more comfortable clarifying questions during the study groups vs. during class time., Conclusions: The impact of study group participation on student exam performance was minimal over the two years of data collection, but there were instances where exam scores were positively impacted. Students perceived value in study group participation even if it did not translate directly to improved exam performance on all exams., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: General surgery resident performance on the American Board of Surgery In-Service Training Exam (ABSITE) has been used to predict American Board of Surgery (ABS) passage rates, selection for remediation programs, and ranking of fellowship applicants. We sought to identify electronic resource study habits of general surgery residents associated with successful test scores., Study Design: A single-institution, retrospective review of general surgery resident use of 2 electronic study resources, Surgical Council on Resident Education (SCORE) and TrueLearn (TL), were evaluated for the 7 months before the 2019 ABSITE. Metrics included TL question performance, SCORE use, and a survey about other reading sources. These metrics were evaluated in 3 ABSITE percentile groupings: ≥80 th , 31 st to 79 th , and ≤30 th ., Results: The ≥80 th and 31 st to 79 th percentile groups scored higher on TL questions, at 69% and 67.7%, respectively, compared with 61.4% for the ≤30 th percentile group (p < 0.03). The ≥80 th percentile group spent on average 14.6 minutes/day on SCORE compared with 5.0 minutes/day and 4.7 minutes/day for the 31 st to 79 th and ≤30 th percentile groups, respectively (p < 0.04). The ≥80 th percentile group spent 34.8 minutes/session (77 sessions) compared with 19.2 minutes/session (49 sessions) and 20.7 minutes/session (43 sessions) in the 31 st to 79 th and ≤30 th percentile groups, respectively (p = 0.009)., Conclusions: Our nomogram incorporates time spent accessing an electronic content-based resource, SCORE, and performance on an electronic question-based resource as a novel method to provide individualized feedback and predict future ABSITE performance., (Published by Elsevier Inc.)

Today, many functional skills are technology-based, so development of a technology-based training program has broad importance. Here we present a computerized functional skills training program that was paired in half of the participants with a commercially available cognitive training (CCT) program. Non-impaired older individuals (NC) aged 60+ (n=45) and similarly aged individuals with mild cognitive impairment (MCI; n=50) were randomized to receive 12 weeks of twice-weekly computerized functional skills training (CFST) or 12 weeks of twice-weekly sessions split between CCT and CFST. Skills trained were use of an ATM; internet banking; ticket kiosk; telephone and internet prescription refill; medication management; and internet shopping. As with previous functional capacity assessments, we focus on completion time for each simulation. 51 participants completed the training program, either by mastering all 6 tasks (34) or completing 12 weeks of training. 44 more participants completed 4 or more training sessions so they were also analyzed for improvement up to their last training session. Completion time for all 6 tests significantly improved from the baseline assessment to the final training session in both groups of participants (all p<0.001 with an average improvement in task completion time of 45%). Further, there was no differential improvement in MCI and NC in the 6 tests from baseline to end of training (all t<1.66, all p>0.12). Finally, combined CCT plus CFST did not differ from CSFT alone on any of the percent-change score measures (all t<1.64, all p>0.11). Both NC and MCI groups evidenced substantial improvements in performance. CCT supplementation led to similar functional gains with half as many training sessions. The NC participants proceeded through the training fairly rapidly even without CCT supplementation; MCI participants required more training but learned equivalently. These findings suggest that even in cases with memory impairments, functional skills can be efficiently learned with training.

Introduction: Medical students who are diagnosed with a specific learning difficulty (SpLD) will typically receive a reasonable adjustment within examinations in the form of modified assessment provision (MAP). This study investigated whether the timing of SpLD diagnosis and subsequent implementation of MAP has an impact on performance in applied medical knowledge multiple choice question (MCQ) assessments., Method: The MCQ performance of 108 students diagnosed with SpLD who received a MAP was monitored and compared with 1960 students who received an unmodified assessment, over 5 years of a medical program. Students who received a SpLD diagnosis in the latter years of the program were identified as not receiving a MAP in assessments prior to diagnosis., Results: Differences were found between declaration and diagnosis, with 44.4% of students who declared and 48.1% who did not declare subsequently receiving a diagnosis. Students with SpLD who receive a MAP increase their applied medical knowledge assessment performance, although there is a delay of up to a year for this impact to reach significance., Conclusion: Early diagnosis of SpLD is necessary to ensure the intended benefit is received from MAP.

Background and Purpose: Nurse practitioner (NP) faculties are challenged to offer programs that balance didactic knowledge with the clinical experiences required to prepare graduates for the complexities of health care. Students have the stress of extrapolating the information they obtain during these programs and applying it to postgraduation certification examinations. Innovative educational tools are necessary to ease the uncertainty that NP students experience to graduate and pass certification examinations. Tools include academic-clinical partnerships (ACPs) to enhance clinical opportunities and resources to integrate diagnostic readiness tests (DRTs) into curricula., Methods: This was a quasi-experimental one group, pretest/posttest design using a convenience sample of NP students randomly assigned to clinical in ACP or non-ACP clinical placements. They completed the DRTs twice during their final program semesters., Conclusions: The overall DRT group scores for the NP students significantly improved over time. The Wilcoxon signed ranks test showed that the posttest scores were significantly higher than the pretest scores. The Mann-Whitney U test revealed no differences between the ACP and non-ACP students. Students performed the best on assessment, diagnosis, management, and pharmacology domains. This demonstrates support for the integration of DRTs into NP programs., Implications for Practice: Integrating DRTs into NP programs can facilitate transition to the NP role.

Introduction: Colleges and schools of pharmacy in the US are faced with the challenge of providing appropriate academic accommodations for students with learning disabilities (SLD) including those with dyslexia, dyscalculia, or dysgraphia. Although there are no population statistics about SLD in pharmacy schools, current data show that their number at higher education institutions across the US has increased. This commentary discusses how the rigorous pharmacy school curriculum affects SLD and proposes creative and innovative measures to overcome these obstacles., Perspective: The shift in the public perception about SLD from a state of stigma to a manageable condition in recent years has greatly contributed to increase the number of SLD enrolled in higher education institutions. Although most colleges and universities can now offer some type of academic accommodation to SLD compared to few years ago, other academic accommodation recommendations to SLD remain challenging to implement, especially for SLD enrolled in pharmacy programs., Implications: SLD enrolled in pharmacy programs could benefit from a multifaceted approach involving the school's office of disability services, medical practitioners, behavioral and language specialists, as well as some sort of curricular changes in order to be academically successful and become practice ready upon graduation., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background and Purpose: Implementation of games is common in pharmacy education, but limited information exists about the relationship between students' game performances and course grades. Our study was designed to determine if scores on a comprehensive web-based review game correlate to overall pharmacotherapeutics course and course series grades., Educational Activity and Setting: Two cohorts of students in Pharmacotherapeutics IV, the last course in a four course series, were administered a web-based quiz review game (Kahoot!) at the end of the course. Student performance on the game was compared to grades throughout the Pharmacotherapeutics course sequence to determine if the games were reflective of the students' performances. All students enrolled in Pharmacotherapeutics IV in 2016 and 2017 were included in the analysis. Pearson correlation was performed on the scores from the review game compared to the grades in the pharmacotherapeutics course series., Findings: A total of 197 students, 111 in the 2016 cohort and 86 in the 2017 cohort, were included in the analysis. The correlation coefficient (r) for the review scores and Pharmacotherapeutics IV course grade was 0.399 and 0.461 for the 2 cohorts (p < 0.001). Almost all component comparisons between the review scores and the other pharmacotherapeutics course grades were also significantly correlated (p < 0.01)., Summary: Student performance on the review game significantly correlated with pharmacotherapeutics course grades. Review games are fun tools to review course content and can serve as an effective method to determine student understanding, progression, and knowledge., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: The preparation for colonoscopy is elaborate and complex. In the context of colorectal cancer screening, up to 11% of patients do not keep their colonoscopy appointments and up to 33% of those attending their appointments have inadequately cleansed bowels that can delay cancer diagnosis and treatment. A smartphone app may be an acceptable and wide-reaching tool to improve patient adherence to colonoscopy., Objective: The aim of this qualitative study was to employ a user-centered approach to design the content and features of a smartphone app called colonAPPscopy to support individuals preparing for their colonoscopy appointments., Methods: We conducted 2 focus group discussions (FGDs) with gastroenterology patients treated at the McGill University Health Centre in Montreal, Canada. Patients were aged 50 to 75 years, were English- or French-speaking, and had undergone outpatient colonoscopy in the previous 3 months; they did not have inflammatory bowel disease or colorectal cancer. FGDs were 75 to 90 min, conducted by a trained facilitator, and audiotaped. Participants discussed the electronic health support tools they might use to help them prepare for the colonoscopy, the content needed for colonoscopy preparation, and the features that would make the smartphone app useful. Recordings of FGDs were transcribed and analyzed using thematic analysis to identify key user-defined content and features to inform the design of colonAPPscopy., Results: A total of 9 patients (7 male and 2 female) participated in one of 2 FGDs. Main content areas focused on bowel preparation instructions, medication restrictions, appointment logistics, communication, and postcolonoscopy expectations. Design features to make the app useful and engaging included minimization of data input, reminders and alerts for up to 7 days precolonoscopy, and visual aids. Participants wanted a smartphone app that comes from a trusted source, sends timely and tailored messages, provides reassurance, provides clear instructions, and is simple to use., Conclusions: Participants identified the need for postcolonoscopy information as well as reminders and alerts in the week before colonoscopy, novel content, and features that had not been included in previous smartphone-based strategies for colonoscopy preparation. The ability to tailor instructions made the smartphone app preferable to other modes of delivery. Study findings recognize the importance of including potential users in the development phase of building a smartphone app., (©Maida J Sewitch, Carlo A Fallone, Peter Ghali, Ga Eun Lee. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 02.07.2019.)

Objectives: Undergraduate medical students experience a considerable amount of stress and anxiety due to frequent exams. The goal of the present study was to examine the development of exam related anxiety and to test for a correlation between anxiety and learning approaches., Methods: A whole class of 212 medical students was invited to participate in the study. During their first term, trait anxiety and learning approaches were assessed by use of the state-trait-anxiety inventory (STAI-T) and the approaches-and-study-skills-inventory-for-students (ASSIST), respectively. Acute state anxiety was assessed twice in the course of the second term. To that extent, the STAI-S in combination with measuring salivary cortisol were employed immediately before two oral anatomy exams., Results: Our most important results were that a surface learning approach correlated significantly with anxiety as a trait and that students with a predominantly strategic approach to learning were the least anxious yet academically most successful., Conclusion: As surface learners are at risk of being academically less successful and because anxiety is a prerequisite for burn-out, we suggest that medical faculties place particular emphasis on conveying strategies for both, coping with stress and successful learning., Competing Interests: The authors have declared that no competing interests exist.

Objective: To develop a scientifically sound and standardized medical language examination for the State of Bavaria according to the requirements set forth by the 87 th Conference of State Health Ministers. This Sprachtest für Ausländische Mediziner (SAM, Language Test for Foreign Physicians) ought to become part of the licensing procedure for foreign physicians in Germany. Using testing stations that are situation-based, it will assess medical language competence and communication skills at the proficiency level of C1. Methods: Case scenarios for four mini-interviews of 10 minutes each were developed. For the written part of the exam, consisting of two separate testing stations with a combined duration of 40 minutes, one video of a physician taking a patient's history and one annotated set of laboratory results were developed. Based on the analysis of existing scientific literature as well as real-life examples, features and characteristics of professional medical language were identified. This served as the basis for the development of itemized rating scales for each of the testing stations. The exam was validated in three simulated trial runs. Each run was video-recorded and subsequently graded by a team of test-raters. Results: 19 participants took part in the three trial runs. A benchmark (gold standard) could be set for 18 of these. A ROC-analysis yielded an AUC-value of .83. This confirmed the predictive quality of the SAM-test. The reliability of the SAM-test could be calculated for only ten participants. The internal consistency, calculated with the use of Cronbach's Alpha, was .85. The pass/fail mark was calculated based on the Youden-Index and yielded a result of >60%. Conclusion: The SAM-test presents a statistically valid medical language examination with a high level of objectivity. As required, it tests language proficiency at the level of C1 and uses authentic communication scenarios within a standardized test setting. Additional studies with larger test samples will help to further validate this test and thus guarantee a higher degree of reliability., Competing Interests: The authors declare that they have no competing interests.

Background and Purpose: This article describes the implementation of pyramid tests, an assessment strategy that utilizes individual and cooperative testing for formal examinations in an elective course for third year pharmacy students. This strategy provides individual accountability and uses group collaboration to extend students depth of thinking through essay responses. Pyramid tests have been suggested as a way to improve grading efficiency compared to traditional tests that use essay questions., Educational Activity and Setting: A two-credit hour pharmacy elective taught by synchronous video conferencing on two campuses of a large public university utilized pyramid tests for both the midterm and final examinations. Each examination had individual and group components and utilized a simple metacognitive question., Findings: The averages from the individual portions of the pyramid tests were similar to the prior year, while the combined group (2/3 weight) and individual (1/3 weight) pyramid test scores averages were slightly higher than the previous year's average (87% compared to 86%, respectively). Student feedback on this assessment technique was generally positive., Summary: This assessment strategy was an efficient way to test students' knowledge. Although it had a collaborative component, it also provided individual accountability. Time spent on course administration and grading was similar to previous years that employed fixed choice assessments without collaborative work., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Introduction: For assessment to fill an educational role, students must see the results generated by assessment as valuable, and actively engage with this feedback in order to support learning. Few studies include examinees as stakeholders in validation beyond general notions of acceptability. Here, we explore students as stakeholders in the validation of a newly implemented assessment., Methods: A student-relevant validity framework based on the unified theory of validity was created and adapted to a survey format. Likert-style items were used to examine first- and second-year medical students' perceptions of a new cumulative assessment, with several open-ended items. Analysis included: mean ratings per subscale of validity evidence, thematic analysis of comments, and a correlation between questionnaire subscores and exam performance., Results: Seventy-seven students participated (20.5%). Student perceptions of the assessment were favourable, with significantly different ratings across validity evidence (Response Process (4.8 (SD = 0.7); scored/6), Content (4.6(0.9)), Consequential (4.4(0.8)), Internal Structure (4.2(0.9)), and Relationship to Other Variables (4.0(1.0))). Exam performance correlated with subscores for Relationship to Other Variables (r = 0.34, p < 0.005) and Response Process (r = 0.24, p < 0.05)., Discussion: Students perceived the assessment as facilitating learning, providing 'checkpoints', and were disappointed when it did not meet their expectations regarding the purpose of assessment. If students perceive that results do not reflect their future performance in clinical environments, or do not align with their perceived purpose of assessment, the educational value of assessment may be limited. It is critical to understand when, and how students engage in interpreting and integrating assessment-generated feedback to ensure that assessment contributes positively to learning.

Introduction: Ongoing monitoring of cohort demographic variation is an essential part of quality assurance in medical education assessments, yet the methods employed to explore possible underlying causes of demographic variation in performance are limited. Focussing on properties of the vignette text in single-best-answer multiple-choice questions (MCQs), we explore here the viability of conducting analyses of text properties and their relationship to candidate performance. We suggest that such analyses could become routine parts of assessment evaluation and provide an additional, equality-based measure of an assessment's quality and fairness., Methods: We describe how a corpus of vignettes can be compiled, followed by examples of using Microsoft Word's native readability statistics calculator and the koRpus text analysis package for the R statistical analysis environment for estimating the following properties of the question text: Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (Grade), word count, sentence count, and average words per sentence (WpS). We then provide examples of how these properties can be combined with equality and diversity variables, and the process automated to provide ongoing monitoring., Conclusions: Given the monitoring of demographic differences in assessment for assurance of equality, the ability to easily include textual analysis of question vignettes provides a useful tool for exploring possible causes of demographic variations in performance where they occur. It also provides another means of evaluating assessment quality and fairness with respect to demographic characteristics. Microsoft Word provides data comparable to the specialized koRpus package, suggesting routine use of word processing software for writing items and assessing their properties is viable with minimal burden, but that automation for ongoing monitoring also provides an additional means of standardizing MCQ assessment items, and eliminating or controlling textual variables as a possible contributor to differential attainment between subgroups.

Background: It has been documented that international students face diverse challenges due to language and cultural barriers. International medical students suffer from personal distress, a lack of support and perform poorer than local fellow-students in clinical examinations. It has been documented that international medical students benefit from peer-led tutorials in their first year. We investigated the effectiveness of a tutorial offered for international medical students in their second year. Methods: A peer-guided examination preparation course with interactive elements for second year international medical students was designed, learning objectives were defined. Two evaluations were undertaken: In a quantitative assessment, students were asked to fill out five multiple-choice-questions at the beginning of every session of the tutorial (pre-test) as well as to participate in a post-test at the end of the semester in which all former multiple-choice-questions were re-used. Using a qualitative approach, participants were asked for their thoughts and comments in a semi-structured interview at the end of the semester. Results: International students (N=12) showed significantly better results in the post- than in the pre-test (t(11)=-8.48, p<.001, d=1.95). Within the interviews, international students (N=10) reported to have benefited from technical and didactic, as well as social learning experiences. The individual lectures students were asked to contribute were discussed controversially. Conclusion: Our peer-guided tutorial for second year international medical students is an effective and well accepted possibility to prepare these students for examinations.

The objective of this study was to compare the examination scores before and after implementation of a study program based on high yield topics on the Council of Resident Education in Obstetrics and Gynecology (CREOG) In-Training Examination. This prospective cohort study compared scores from academic years 2012 to 2014 of University of Hawai'i obstetrics and gynecology residents who participated in a directed study program based on selected high yield topics from the CREOG Test Item Summary Booklet. Topics were considered high yield if more than 75% of the program residents answered the topic questions incorrectly during the immediately preceding CREOG In-Training Examination administration. Residents were assigned topics to research and present at monthly teaching sessions. The presentations were made accessible in a wiki website. The intervention was initiated in 2012 and discontinued in 2013. The primary outcome was the difference among CREOG In-Training Examination scores before the study program, during the study program, and after the study program was discontinued. Only scores of residents who sat for all three exams were included. Eleven residents were present during the duration of the study period and sat for all three CREOG examinations. During the year of the educational activity, paired individual resident CREOG exams scores increased significantly from the 2012 CREOG administration (mean = 194.7) to the 2013 CREOG administration (mean = 208.2). These findings demonstrate that the CREOG Test Item Summary Booklet and the wiki platform can be used to effectively direct educational efforts resulting in improvements in CREOG examination performance., Competing Interests: None of the authors identify any conflict of interest.

We describe the experience of study circles on the theme 'good obstetrics practices backed by scientific evidence' and argue that they prepared midwifery students to dialogue with hospital staff and empowered them in the process of negotiating the implementation of practices put forward by the International Confederation of Midwives (ICM). We conclude that study circles are an efficient strategy of preparing midwifery students to be active participants in the maternity care team and lead discussions of evidenced-based practice., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

The influence of individual differences on learners' study time allocation has been emphasised in recent studies; however, little is known about the role of individual thinking styles (analytical versus intuitive). In the present study, we explored the influence of individual thinking styles on learners' application of agenda-based and habitual processes when selecting the first item during a study-time allocation task. A 3-item cognitive reflection test (CRT) was used to determine individuals' degree of cognitive reliance on intuitive versus analytical cognitive processing. Significant correlations between CRT scores and the choices of first item selection were observed in both Experiment 1a (study time was 5 seconds per triplet) and Experiment 1b (study time was 20 seconds per triplet). Furthermore, analytical decision makers constructed a value-based agenda (prioritised high-reward items), whereas intuitive decision makers relied more upon habitual responding (selected items from the leftmost of the array). The findings of Experiment 1a were replicated in Experiment 2 notwithstanding ruling out the possible effects from individual intelligence and working memory capacity. Overall, the individual thinking style plays an important role on learners' study time allocation and the predictive ability of CRT is reliable in learners' item selection strategy., (© 2016 International Union of Psychological Science.)

Introduction: Tablet-based assessments offer benefits over scannable-paper assessments; however, there is little known about the impact to the variability of assessment scores., Methods: Two studies were conducted to evaluate changes in rating technology. Rating modality (paper vs tablets) was manipulated between candidates (Study 1) and within candidates (Study 2). Average scores were analyzed using repeated measures ANOVA, Cronbach's alpha and generalizability theory. Post-hoc analyses included a Rasch analysis and McDonald's omega., Results: Study 1 revealed a main effect of modality (F (1,152) = 25.06, p < 0.01). Average tablet-based scores were higher, (3.39/5, 95% CI = 3.28 to 3.51), compared with average scan-sheet scores (3.00/5, 95% CI = 2.90 to 3.11). Study 2 also revealed a main effect of modality (F (1, 88) = 15.64, p < 0.01), however, the difference was reduced to 2% with higher scan-sheet scores (3.36, 95% CI = 3.30 to 3.42) compared with tablet scores (3.27, 95% CI = 3.21 to 3.33). Internal consistency (alpha and omega) remained high (>0.8) and inter-station reliability remained constant (0.3). Rasch analyses showed no relationship between station difficulty and rating modality., Discussion: Analyses of average scores may be misleading without an understanding of internal consistency and overall reliability of scores. Although updating to tablet-based forms did not result in systematic variations in scores, routine analyses ensured accurate interpretation of the variability of assessment scores., Conclusion: This study demonstrates the importance of ongoing program evaluation and data analysis.

Objectives: The current study aimed to carry out a post-validation item analysis of multiple choice questions (MCQs) in medical examinations in order to evaluate correlations between item difficulty, item discrimination and distraction effectiveness so as to determine whether questions should be included, modified or discarded. In addition, the optimal number of options per MCQ was analysed., Methods: This cross-sectional study was performed in the Department of Paediatrics, Arabian Gulf University, Manama, Bahrain. A total of 800 MCQs and 4,000 distractors were analysed between November 2013 and June 2016., Results: The mean difficulty index ranged from 36.70-73.14%. The mean discrimination index ranged from 0.20-0.34. The mean distractor efficiency ranged from 66.50-90.00%. Of the items, 48.4%, 35.3%, 11.4%, 3.9% and 1.1% had zero, one, two, three and four nonfunctional distractors (NFDs), respectively. Using three or four rather than five options in each MCQ resulted in 95% or 83.6% of items having zero NFDs, respectively. The distractor efficiency was 91.87%, 85.83% and 64.13% for difficult, acceptable and easy items, respectively ( P <0.005). Distractor efficiency was 83.33%, 83.24% and 77.56% for items with excellent, acceptable and poor discrimination, respectively ( P <0.005). The average Kuder-Richardson formula 20 reliability coefficient was 0.76., Conclusion: A considerable number of the MCQ items were within acceptable ranges. However, some items needed to be discarded or revised. Using three or four rather than five options in MCQs is recommended to reduce the number of NFDs and improve the overall quality of the examination., Competing Interests: CONFLICT OF INTEREST The authors declare no conflicts of interest.

Background: To define resources deemed most important to medical students on their general surgery clerkship, we evaluated their material utilization., Methods: A prospective study was conducted amongst third-year medical students using a 20-item survey. Descriptive statistics were performed on the demographics. Kruskal-Wallis and Mann-Whitney analyses were performed on the Likert responses (α = 0.05)., Results: Survey response was 69.2%. Use of review books and Internet was significantly higher compared to all other resources (p < 0.05). Wikipedia was the most used Internet source (39.1%). 56% never used textbooks. Analyses of surgery subject exam (NBME) results or intended specialty with resources used showed no statistical relationship (all p > 0.05)., Conclusions: Resources used by students reflect access to high-yield material and increased Internet use. The Internet and review books were used more than the recommended textbook; NBME results were not affected. Understanding study habits and resource use will help guide curricular development and students' self-regulated learning., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Nursing students find bioscience subjects challenging. Bioscience exams pose particular concerns for these students, which may lead to students adopting a surface-approach to learning., Objectives: To promote student collective understanding of bioscience, improve their confidence for the final exam, and improve deeper understanding of bioscience., Design: In order to address exam anxiety, and improve student understanding of content, this student engagement project involved nursing students collaborating in small groups to develop multiple-choice questions and answers, which became available to the entire student cohort., Settings: This study was conducted at two campuses of an Australian university, within a first year bioscience subject as part of the undergraduate nursing programme., Participants: All students enrolled in the subject were encouraged to attend face-to-face workshops, and collaborate in revision question writing. Online anonymous questionnaires were used to invite student feedback on this initiative; 79 respondents completed this feedback., Methods: Students collaborated in groups to write revision questions as part of in-class activities. These questions were made available on the student online learning site for revision. An online feedback survey was deployed at the conclusion of all workshops for this subject, with questions rated using a Likert scale., Results: Participants indicated that they enjoyed the opportunity to collaborate in this activity, and almost all of these respondents used these questions in their exam preparation. There was strong agreement that this activity improved their confidence for the final exam. Importantly, almost two-thirds of respondents agreed that writing questions improved their understanding of content, and assisted in their active reflection of content., Conclusions: Overall, this initiative revealed various potential benefits for the students, including promoting bioscience understanding and confidence. This may improve their long-term understanding of bioscience for nursing practice, as registered nurses' bioscience knowledge can impact on patient outcomes., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objective: Mock oral examinations are often used to prepare residents for the American Board of Surgery certifying examination. Another potential use of these examinations is to identify programmatic weaknesses. Results from a multi-institutional mock oral examination were evaluated to determine if specific areas of weakness within each of the participating programs could be identified to facilitate program development., Design: A mock oral examination was administered annually consisting of 3 examination rooms per resident with 3 cases in each room. Case categories included core general surgery and subspecialties and cases were changed yearly. Each case included facets of patient management from history and physical examination, and differential diagnosis to postoperative care and professional behaviors., Setting: General Surgery programs at 3 academic medical centers-Northwestern University, Rush University, and University of Illinois at Chicago., Participants: A total of 259 resident examinations of fourth- and fifth-year general surgery residents over a 7-year period., Results: A total of 2331 individual resident cases were evaluated with an overall case pass rate of 50.2% across all 3 programs. The weakest case category for each program was different (A = vascular 40.0% pass, B = trauma 41.4% pass, and C = breast 30.0% pass). All programs scored above their mean in gastrointestinal and abdominal surgery and below their mean in vascular surgery. Within vascular surgery, the weakest facet of patient management also differed between programs (A = select tests 44.3% pass, B = complications 57.0% pass, and C = history and physical 55.4% pass)., Conclusions: A standardized mock oral examination is able to identify topic areas of relative strength and weakness that differ between programs. These results can be used to define focused areas for improvement within training programs, guide rotation schedules, and improve didactic curricula., (Copyright © 2017 Association of Program Directors in Surgery. All rights reserved.)

Background: Faculty continue to observe students struggling as they adapt their study strategies to learn nursing core content., Objectives: This study described the study habits of Bachelor of Science in Nursing (BSN) students prior to admission to the program., Design: This study used a descriptive qualitative research design., Settings and Participants: A purposive sample of 19 BSN students (juniors [n=10] and seniors [n=9]) from a 4-year public Midwestern university were included in this study., Methods: Two focus group sessions, using a semi-structured interview guide, were conducted in the spring semester of 2013., Results: The four themes which emerged from the analysis of data were: "I just got it," "I had a lot of time then," "I studied alone" mostly, and "…a little struggle with the sciences.", Conclusions: The findings suggest the BSN students did not study much or employed poor study strategies during their years completing general education courses. Academic support is needed by students prior to admission to the nursing program so they can learn effective study skills and modify their study habits for easier adaptation to the rigors of nursing education., (Published by Elsevier Ltd.)

During the last decade, concerns over veterinary students' stress have been expressed in several studies, and the need for student support has become evident. In addition, the importance of professional and personal identity development in veterinary curricula has been widely recognized. There is a need to integrate academic and professional skills instruction with training in personal-life balance. Even though tools for student support and stress management exist within universities, reports on active and creative practices in veterinary education are scarce. We report here a course that has been organized twice as an optional part of veterinary studies to provide students with tools for everyday life and personal development toward a future veterinary career. Students defined their own learning objectives in this course, and they reported having received tools and knowledge especially for time management and stress control. The course gave the students an opportunity to step back from their busy schedules, think over their lives and actions, and even take concrete actions that have a positive effect on their well-being. The rich qualitative material collected during the pilot course has been used not only for developing the course further but also for development of the mandatory curriculum.

Background: Dynamic testing has been proposed as a testing approach that is less disadvantageous for children who may be potentially subject to bias when undertaking conventional assessments. For example, those who encounter high levels of test anxiety, or who are unfamiliar with standardized test procedures, may fail to demonstrate their true potential or capabilities. While dynamic testing has proven particularly useful for special groups of children, it has rarely been used with gifted children., Aim: We investigated whether it would be useful to conduct a dynamic test to measure the cognitive abilities of intellectually gifted children. We also investigated whether test anxiety scores would be related to a progression in the children's test scores after dynamic training., Sample: Participants were 113 children aged between 7 and 8 years from several schools in the western part of the Netherlands. The children were categorized as either gifted or average-ability and split into an unguided practice or a dynamic testing condition., Methods: The study employed a pre-test-training-post-test design. Using linear mixed modelling analysis with a multilevel approach, we inspected the growth trajectories of children in the various conditions and examined the impact of ability and test anxiety on progression and training benefits., Results and Conclusions: Dynamic testing proved to be successful in improving the scores of the children, although no differences in training benefits were found between gifted and average-ability children. Test anxiety was shown to influence the children's rate of change across all test sessions and their improvement in performance accuracy after dynamic training., (© 2016 The British Psychological Society.)

The Medical-Surgical Nursing Certification Board (MSNCB) is a professional organization whose mission is to validate excellence in medical-surgical nursing. MSNCB administers the Certified Medical- Surgical Registered Nurse (CMSRN[R]) and Certified in Care Coordination and Transition Management (CCCTM) certification programs because certification is the recognized path for registered nurses to build and demonstrate commitment, confidence, and credibility. Certification provides an added credential beyond licensure. It demonstrates, by examination, that the registered nurse adheres to specialized nursing standards and has acquired a core body of specialized knowledge in his or her practice or specialty. The topic of this article is part of the comprehensive examination given by MSNCB. The following scenario and questions offer an example that potential certificants may use to test their knowledge.

Objective: We sought to determine whether sequential participation in a multi-institutional mock oral examination affected the likelihood of passing the American Board of Surgery Certifying Examination (ABSCE) in first attempt., Design: Residents from 3 academic medical centers were able to participate in a regional mock oral examination in the fall and spring of their fourth and fifth postgraduate year from 2011 to 2014. Candidate׳s highest composite score of all mock orals attempts was classified as risk for failure, intermediate, or likely to pass. Factors including United States Medical Licensing Examination steps 1, 2, and 3, number of cases logged, American Board of Surgery In-Training Examination performance, American Board of Surgery Qualifying Examination (ABSQE) performance, number of attempts, and performance in the mock orals were assessed to determine factors predictive of passing the ABSCE., Results: A total of 128 mock oral examinations were administered to 88 (71%) of 124 eligible residents. The overall first-time pass rate for the ABSCE was 82%. There was no difference in pass rates between participants and nonparticipants. Of them, 16 (18%) residents were classified as at risk, 47 (53%) as intermediate, and 25 (29%) as likely to pass. ABSCE pass rate for each group was as follows: 36% for at risk, 84% for intermediate, and 96% for likely pass. The following 4 factors were associated with first-time passing of ABSCE on bivariate analysis: mock orals participation in postgraduate year 4 (p = 0.05), sequential participation in mock orals (p = 0.03), ABSQE performance (p = 0.01), and best performance on mock orals (p = 0.001). In multivariable logistic regression, the following 3 factors remained associated with ABSCE passing: ABSQE performance, odds ratio (OR) = 2.9 (95% CI: 1.3-6.1); mock orals best performance, OR = 1.7 (1.2-2.4); and participation in multiple mock oral examinations, OR = 1.4 (1.1-2.7)., Conclusions: Performance on a multi-institutional mock oral examination can identify residents at risk for failure of the ABSCE. Sequential participation in mock oral examinations is associated with improved ABSCE first-time pass rate., (Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Purpose: The move toward competency-based education will require medical schools and postgraduate training programs to restructure learning environments to motivate trainees to take personal ownership for learning. This qualitative study explores how medical students select and implement study strategies while enrolled in a unique, nontraditional program that emphasizes reflection on performance and competence rather than relying on high-stakes examinations or grades to motivate students to learn and excel., Method: Fourteen first-year medical students volunteered to participate in three, 45-minute interviews (42 overall) scheduled three months apart during 2013-2014. Two medical educators used structured interview guides to solicit students' previous assessment experiences, preferred learning strategies, and performance monitoring processes. Interviews were digitally recorded and transcribed verbatim. Participants confirmed accuracy of transcripts. Researchers independently read transcripts and met regularly to discuss transcripts and judge when themes achieved saturation., Results: Medical students can adopt an assessment for learning mind-set with faculty guidance and implement appropriate study strategies for mastery-learning demands. Though students developed new strategies at different rates during the year, they all eventually identified study and performance monitoring strategies to meet learning needs. Students who had diverse learning experiences in college embraced mastery-based study strategies sooner than peers after recognizing that the learning environment did not reward performance-based strategies., Conclusions: Medical students can take ownership for their learning and implement specific strategies to regulate behavior when learning environments contain building blocks emphasized in self-determination theory. Findings should generalize to educational programs seeking strategies to design learning environments that promote self-regulated learning.

AN NHS trust has set up a quality assurance panel and created an e-portfolio in a bid to ensure its nurses are prepared for the nursing regulator's revalidation model.

Students' self-reported study skills and beliefs are often inconsistent with empirically supported (ES) study strategies. However, little is known regarding instructors' beliefs about study skills and if such beliefs differ from those of students. In the current study, we surveyed college students' and instructors' knowledge of study strategies and had both groups evaluate the efficacy of learning strategies described in six learning scenarios. Results from the survey indicated that students frequently reported engaging in methods of studying that were not optimal for learning. Instructors' responses to the survey indicated that they endorsed a number of effective study skills but also held several beliefs inconsistent with research in learning and memory (e.g., learning styles). Further, results from the learning scenarios measure indicated that instructors were moderately more likely than students to endorse ES learning strategies. Collectively, these data suggest that instructors exhibited better knowledge of effective study skills than students, although the difference was small. We discuss several notable findings and argue for the improvement of both students' and instructors' study skill knowledge.

Objectives: To understand the ability of worm detection of staff of centers for disease control and prevention (CDC) in China, so as to promote the ability construction., Methods: In each province, four competitors were selected from the institutions of parasitic diseases control to attend the National Technique Competition for Parasitic Disease Diagnosis and the results of competition were collected and analyzed., Results: The average scores of microscopic identification and slide preparation of all the 124 competitors were 27.3 and 7.6 respectively and the scores were increased significantly (t = 3.169, 5.009, both P < 0.05) compared to those in 2012. The average detection rate of helminthes was 62.7%, and it was increased significantly (χ2 = 28.630, P < 0.05) compared to that in 2012. The scores of competitors of different genders, ages, and profession titles were significantly different (t = 1.400, 2.080, F = 2.366-3.864, all P < 0.05). The scores of competitors of provinces with the control task of parasites were higher than those without any control task (t = 6.650, 4.630, both P < 0.01)., Conclusions: The competition has enhanced the ability of staff of CDCs, especially for the young staff. However, the ability of detection for soil transmitted helminth eggs should be intensified. Monitoring sites should be established in low endemic areas of parasites and provinces without the prevention and control task and the training for the professional staff should be strengthened.

Background and Objectives: High-stakes didactic testing assesses competency. Exams are stressful, and decreasing anxiety may enhance learning. Academic progression and graduation rates may result when higher levels of hopeful thinking (the belief in one's ability to achieve desired goals), and certain achievement goal orientation (why one desires to succeed) are present., Methods: This non-experimental study engaged undergraduate nursing students via surveys to examined relationships among hopeful thinking, goal orientation, and scores on standardized high-stakes examination of students., Results: Regression analyses (N = 151) indicated that hopeful thinking was significantly related to higher exam scores, and that performance-avoidance goal scores were significantly related to lower scores., Conclusion: The positive relationship between hopeful thinking and exam scores suggests the need to consider supporting hopeful thinking in nursing education. Additional research may explicate the relationship between performance-avoidance and scores on high-stakes exams.

Background Studying regularly has been a known method for better memory and long term retention of a subject. Getting students to study on a regular basis has been tried in many ways and its impact is increased if they understand the importance and value the efficiency of it. Objectives With large number of students, it would be a time consuming process to follow one on one interactions or study sessions. Hence, we introduced a new strategy, the "Question of the Day", which is interesting, challenging and most of all; it has produced positive influence on the examination performance of the students who performed this task. Main objective of this study was to make students answer questions related to the topics taught every day. Method Regular studying and updating the subject knowledge was provided through Question of the Day (Annexure-1). The students were given the questions on a regular basis during dissection classes and were asked to document the answers for those questions. Result The students who worked on the "Question of the Day" scored significantly higher in the exams than those who did not. The results of the opinion survey clearly indicated that this exercise was liked by most of the students. Conclusion "Question of the day" did have a positive influence on the student's performance. Most of the students felt that this exercise had a positive impact on their study methods, interaction with peers and teachers, retention and recollection of the knowledge.

Background and Objectives: Our objective was to examine the predictive validity of the American Board of Family Medicine's (ABFM) In-Training Examination (ITE) with regard to predicting outcomes on the ABFM certification examination., Methods: This study used a repeated measures design across three levels of medical training (PGY1--PGY2, PGY2--PGY3, and PGY3--initial certification) with three different cohorts (2010--2011, 2011--2012, and 2012--2013) to examine: (1) how well the residents' ITE scores correlated with their test scores in the following year, (2) what the typical score increase was across training years, and (3) what was the sensitivity, specificity, positive predictive value, and negative predictive value of the PGY3 scores with regard to predicting future results on the MC-FP Examination., Results: ITE scores generally correlate at about .7 with the following year's ITE or with the following year's certification examination. The mean growth from PGY1 to PGY2 was 52 points, from PGY2 to PGY3 was 34 points, and from PGY3 to initial certification was 27 points. The sensitivity, specificity, positive predictive value, and negative predictive value were .91, .47, .96, and .27, respectively., Conclusion: The ITE is a useful predictor of future ITE and initial certification examination performance.