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Objectives: A paucity of information exists to advise medical school applicants who have had to retake the Medical College Admission Test (MCAT) to achieve a competitive score. To better advise repeat test takers from West Virginia and other Appalachian and southern areas, MCAT data from West Virginia applicants were analyzed and compared with national data., Methods: In the application cycles of 2017-2020, the following factors were analyzed in relation to medical school acceptance in West Virginia applicants: MCAT scores, the number of test-taking attempts, biology-chemistry-physics-math grade point average, time between test-taking attempts, and academic major. MCAT data from medical school applicants from West Virginia who took the test more than once also were compared with national data., Results: Of the total repeat test takers from West Virginia (N = 285) in the study timeframe, 57 (20%) were ultimately accepted into medical school. Factors associated with medical school acceptance were as follows: first MCAT test score (odds ratio [OR] 1.3, 95% confidence level [CL] 1.2-1.4, P < 0.001), change in MCAT test score (OR 1.2, 95% CL 1.1-1.3, P = 0.0015), and biology-chemistry-physics-math grade point average (OR 15.1, 95% CL 4.2-54.8, P < 0.0001). The highest benefit for improved scores occurred between the first and second attempts. The highest point gain occurred when the first MCAT score was in the range of 477 to 487 (<1st-12th percentile); this finding was not found in the national data., Conclusions: Although the study was limited to West Virginia medical school applicants, this information could prove useful in advising premedical applicants from other Appalachian and southern US areas.

In low-stakes assessments, test performance has few or no consequences for examinees themselves, so that examinees may not be fully engaged when answering the items. Instead of engaging in solution behaviour, disengaged examinees might randomly guess or generate no response at all. When ignored, examinee disengagement poses a severe threat to the validity of results obtained from low-stakes assessments. Statistical modelling approaches in educational measurement have been proposed that account for non-response or for guessing, but do not consider both types of disengaged behaviour simultaneously. We bring together research on modelling examinee engagement and research on missing values and present a hierarchical latent response model for identifying and modelling the processes associated with examinee disengagement jointly with the processes associated with engaged responses. To that end, we employ a mixture model that identifies disengagement at the item-by-examinee level by assuming different data-generating processes underlying item responses and omissions, respectively, as well as response times associated with engaged and disengaged behaviour. By modelling examinee engagement with a latent response framework, the model allows assessing how examinee engagement relates to ability and speed as well as to identify items that are likely to evoke disengaged test-taking behaviour. An illustration of the model by means of an application to real data is presented., (© 2019 The Authors. British Journal of Mathematical and Statistical Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Thai trauma nurses play a vital role in neuroprotective nursing care of patients with moderate or severe traumatic brain injury. Nurses' knowledge of the evidence underpinning initial neuroprotective nursing care vital to safe and high-quality patient care. However, the current state of knowledge of Thai trauma nurses is poorly understood. In this study, we investigated Thai nurses' knowledge of neuroprotective nursing care of patients with moderate or severe traumatic brain injury. Data were collected by a survey, comprising a section on participant characteristics and series of multiple-choice questions. All registered nurses (n = 22) and nursing assistants (n = 13) from the trauma ward of a regional Thai hospital were invited to participate: the response rate was 100%. Participants had limited knowledge of carbon dioxide monitoring; causes and implications of hypercapnia; mean arterial pressure and cerebral perfusion pressure targets; management of sedatives and analgesics; and management of hyperthermia. Improving their knowledge focusing on knowledge deficits through educational training and implementation of evidence-based practice is essential to improve the safety and quality of care for Thai patients with moderate or severe traumatic brain injury., (© 2020 John Wiley & Sons Australia, Ltd.)

Introduction: In high-stakes assessment, the measurement precision of pass-fail decisions is of great importance. A concept for analyzing the measurement precision at the cut score is conditional reliability, which describes measurement precision for every score achieved in an exam. We compared conditional reliabilities in Classical Test Theory (CTT) and Item Response Theory (IRT) with a special focus on the cut score and potential factors influencing conditional reliability at the cut score., Methods: We analyzed 32 multiple-choice exams from three Swiss medical schools comparing conditional reliability at the cut score in IRT and CCT. Additionally, we analyzed potential influencing factors such as the range of examinees' performance, year of study, and number of items using multiple regression., Results: In CTT, conditional reliability was highest for very low and very high scores, whereas examinees with medium scores showed low conditional reliabilities. In IRT, the maximum conditional reliability was in the middle of the scale. Therefore, conditional reliability at the cut score was significantly higher in IRT compared with CTT. It was influenced by the range of examinees' performance and number of items. This influence was more pronounced in CTT., Discussion: We found that conditional reliability shows inverse distributions and conclusions regarding the measurement precision at the cut score depending on the theory used. As the use of IRT seems to be more appropriate for criterion-oriented standard setting in the framework of competency-based medical education, our findings might have practical implications for the design and quality assurance of medical education assessments.

Introduction: Standards 2016 require schools/colleges of pharmacy (s/cop) to assess students' readiness to enter advanced pharmacy practice experiences (APPEs). However, literature describing how schools are meeting this standard is limited. The purpose of this study was to conduct an environmental scan to describe how s/cop assess student readiness to enter APPEs., Methods: A web-based survey was distributed to assessment leads at United States s/cop, regardless of accreditation status. Respondents answered questions related to their current approach to assessing student APPE readiness, existence of intentional assessment plans, competencies used, assessment methods, benchmarks, and remediation strategies. Aggregate data were analyzed using descriptive statistics., Results: Fifty-two S/COP (36.1%) responded. The majority (90.1%) were fully accredited schools. Most respondents have an intentional APPE readiness plan (73.5%), although the duration since implementation varied. There was no consensus among schools on which competencies informed APPE readiness with 67.3% listing Center for the Advancement of Pharmacy Education (CAPE) 2013 outcomes, 61.2% Guidance for Standards 2016 Appendix A, 53.1% pre-APPE domains (Standards 2007), and 30.6% Entrustable Professional Activities. Twenty-eight S/COP (57.1%) reported having individual student-level data to assess student APPE readiness. The most common methods for validating student APPE readiness were preceptor (48.9%) and student (44.9%) surveys., Conclusions: This environmental scan begins to identify trends in how S/COP is approaching the assessment of student readiness to begin APPEs. Further research is needed to identify best practices and practical methods to ensure compliance with current accreditation standards., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: Numerical errors can cause unintentional harm to patients and are a burden to healthcare systems worldwide. There is a paucity of research regarding numerical competence in pharmacists and pharmacy students and how this should be assessed within undergraduate and licensure assessments., Methods: Two numeracy assessments were given to year three and four pharmacy students at the University of Sunderland, United Kingdom. One paper included ten multiple-choice questions (MCQs) and the second ten free-text answer questions. Participants were then given an evaluation questionnaire to explore their perceptions about the assessments and numeracy in clinical practice., Results: A response rate of 75% (n = 247) was achieved, with 60.9% of students passing the MCQ and 27.9% passing the free-text answer assessments. There were statistically significant differences in pass rates depending on year of study, ethnicity, and previous mathematics qualifications. Participants were asked if numeracy was an important skill for pharmacists in practice; 57.9% thought it were essential and 36.4% quite important. However, only 1.4% felt sufficiently supported in the development of the required numeracy skills, and this has prompted a redesign of teaching and assessment at the university., Conclusions: Educators need to ensure taught and assessed numeracy is reflective of and transferable to pharmacy practice, whilst ensuring students are supported effectively and engaged. This is likely to be achieved with integrated and clinically focused teaching approaches and appropriately constructed assessments throughout the pharmacy programme., Competing Interests: Declaration of competing interest None., (Copyright © 2020. Published by Elsevier Inc.)

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.)

In 2015, the Medical College Admission Test (MCAT) was redesigned to better assess the concepts and reasoning skills students need to be ready for the medical school curriculum. During the new exam's design and rollout, careful attention was paid to the opportunities examinees had to learn the new content and their access to free and low-cost preparation resources. The design committee aimed to mitigate possible unintended effects of the redesign, specifically increasing historical mean group differences in MCAT scores for examinees from lower socioeconomic status (SES) backgrounds and races/ethnicities underrepresented in medicine compared with those from higher SES backgrounds and races/ethnicities not underrepresented in medicine.In this article, the authors describe the characteristics and scores of examinees who took the new MCAT exam in 2017 and compare those trends with historical ones from 2013, presenting evidence that the diversity and performance of examinees has remained stable even with the exam's redesign. They also describe the use of free and low-cost MCAT preparation resources and MCAT preparation courses for examinees from higher and lower SES backgrounds and who are enrolled in undergraduate institutions with more and fewer resources, showing that examinees from lower SES backgrounds and who attend institutions with fewer resources use many free and low-cost test preparation resources at lower rates than their peers. The authors conclude with a description of the next phase of this research: to gather qualitative and quantitative data about the preparation strategies, barriers, and needs of all examinees, but especially those from lower SES and underrepresented racial/ethnic backgrounds.

Introduction: Sleep deprivation is associated with poor academic performance, although the impact on pharmacy students has been minimally reported. This study examined sleep quality in pharmacy students in the first (P1), second (P2), and third (P3) professional years during perceived low and high stress periods in a course. Individual sleep and environmental factors were also explored., Methods: This prospective cohort study used an 18-item survey adapted from the Pittsburgh Sleep Quality Index (PSQI) that included demographics, individual sleep components, and factors affecting sleep. Surveys were administered at the beginning of the quarter (low stress) and the week before final exams (high stress). Chi-square tests compared categorical variables; ANOVA/ANCOVA tests compared continuous variables., Results: During high stress, PSQI scores worsened among all classes and was significant for the P3s. Average sleep duration was 6.64 (SD 1.18) and 6.8 (SD 1.18) hours per night for P1s and P3s, respectively, at the beginning of the quarter; both groups had significant reduction in sleep duration at the end of the quarter. There were no significant correlations between PSQI and exam scores. Factors impacting sleep such as exercise, use of technology at bedtime, and work hours outside of school decreased during high times of stress, for P1s, P2s, and P3, respectively., Conclusions: Students demonstrated worsening sleep quality during high stress periods and less sleep than recommended. Academic performance was not adversely affected. Future research should use sleep logs and other performance measures to determine the impact of sleep quality on academic success and wellbeing., Competing Interests: Declaration of competing interest Dr. Lee is a consultant for Shire, Takeda Pharmaceuticals, Otsuka Pharmaceutical Co., Ltd, and TrueLearn., (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.)

Introduction: Studies have been conducted to identify factors that may predict North American Pharmacist Licensure Examination (NAPLEX) outcomes, but there is no proposed single or combination of predictors that can be implemented reliably in academia. We aimed to develop a NAPLEX outcomes predictive model that could be practical, measurable, and reliable., Methods: The study cohort consisted of students who graduated from 2012 to 2016 who had taken NAPLEX and whose first-attempt examination scores were available to the school of pharmacy. Students were considered to have poor performance on NAPLEX if they received an overall score of less than or equal to 82. Linear and logistic regression analysis were utilized to identify independent predictors., Results: Seventy of 433 (16.2%) students were identified as poor performers. Independent factors that were associated with a poor outcome on NAPLEX were: age >28 years at graduation, Pharmacy College Admission Test scaled score <74, High Risk Drug Knowledge Assessment score <90, third-year Pharmacy Curriculum Outcome Assessment scaled score <349, and grades of <74 in more than three courses. These predictors were utilized to stratify students into four risk groups: Low, Intermediate-1, Intermediate-2, and High. Mean NAPLEX scores for these groups were 106.4, 97.4, 87.1, and 75.1, respectively., Conclusions: The model can be used as a practical tool to identify students who are at risk for poor performance on NAPLEX. Four of the five predictors in the model could be generalizable to other schools of pharmacy., (Copyright © 2019. Published by Elsevier Inc.)

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.)

Introduction: Many predictors of success on the North American Pharmacist Licensure Exam (NAPLEX) have been studied, but little information is available regarding the effect of assessments in the clinical skills setting on student success. One way to determine if these assessments affect NAPLEX success is to review student performance in clinical skills laboratory courses (termed patient care lab ["PCL"] at our institution), which incorporate such assessments., Methods: Students (n = 88) enrolled in a four quarter PCL sequence completed several individual assessments (both knowledge and skills-based), including drug information (DI) quizzes/final exams, patient case presentations and associated critical thinking questions, and formal DI responses. Linear regression assessed the relationship between PCL assessments and NAPLEX scores. Statistical tests were performed using IBM SPSS version 22 with a p-value <0.05 considered significant., Results: While drug information responses were not predictive of total NAPLEX scores (p = 0.192), the patient case presentation and associated critical thinking questions predicted 31.1% of variability (p < 0.05)., Conclusion: Performance of one cohort of students on certain pharmacy clinical skills lab assessments was predictive of total scores on the NAPLEX. Students who struggle with assessments in the clinical skills lab setting may be targets for early intervention to help improve the likelihood of success. More research is needed to fully elucidate the relationship between assessments in the clinical skills lab setting and NAPLEX performance., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Introduction: The purpose of this study was to determine whether a study skills course taken by first professional year pharmacy students improved their self-assessment of study skills and strategies., Methods: This study analyzed student responses to the Learning and Study Strategies Inventory (LASSI), an online assessment with questions in 10 subject areas: anxiety, motivation, concentration, test strategies, study aids, selecting main ideas, attitude, self-testing, information processing, and time management. Students in an elective study skills course in 2012-2017 completed the self-assessment prior to and at the end of the course. Wilcoxon signed-rank test was performed to compare class score pre- and post-course., Results: Over a five-year period, 312 students completed both the pre- and post-course LASSI assessment. Average percentile scores increased significantly from the beginning to the end of the course in all 10 areas. Notably, average pre-course scores in seven subject areas (attention, concentration, self-testing, selecting main ideas, study aids, time management, and test strategies) were all below the 50th percentile, indicating a need for improvement in those skills to see increased academic success. Average post-course scores in each area increased to between the 50th and 75th percentile., Conclusions: This evaluation shows that a study skills course improves students' self-assessment of skills and attitudes associated with success in post-secondary education. Future studies will look at the effect of such a course on academic outcomes., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Meaningful use of electronic medical records (EMRs) is critical for providing high-quality, patient-centered care. However, many pharmacy students are not exposed to EMRs until the experiential components of the curriculum., Educational Activity and Setting: We created a low-cost simulated EMR (SEMR) using Microsoft PowerPoint software (Microsoft, Redmond, WA, Version 16.16) to use in a case-based application course for second-year pharmacy students for two consecutive years., Findings: Pre- and post-assessment surveys of 162 students indicated that perceived confidence and efficiency navigating EMRs improved after the activity. Students agreed that the activity enhanced learning, improved understanding of how to extract meaningful data from EMRs, benefited their preparation for the fourth professional year, and demonstrated the role of informatics in patient care., Summary: Incorporation of a SEMR using Microsoft PowerPoint enhances student perceptions of proficiency in navigating the patient medical record. Adoption of similar activities into pharmacy curricula may be an attractive option when adequate financial resources for simulation are unavailable., (Copyright © 2019 Elsevier Inc. All rights reserved.)

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.)

Objective: The final year of undergraduate medical education in Germany is called the practical year (PY), where emphasis is placed on developing practical skills requisite of soon-to-be physicians. Many students choose to spend part of this year abroad, yet little is known about their results on the medical licensing examinations. Is there a predisposition of high-performing students to go abroad as compared to lower performers? Are international health electives during the PY followed by higher scores in the final section of the German medical licensing examination (GMLE2)? Methods: We conducted a retrospective cohort study among undergraduate medical students at the LMU Munich, who participated in the final section of the German medical licensing examination between autumn 2009 and spring 2011. Of the 1,731 eligible students, 554 (32%) participated in our study. We analyzed for statistical associations of international health electives with written test scores of both sections of the medical licensing examination as well as grades earned during medical school training. We then used multiple regression analysis to identify relevant predictors of GMLE2 scores. Results: Approximately half of study participants pursued international health electives during the PY (51.1%). The number of students going abroad increased with the scores achieved on the first section of the medical licensing examination (GMLE1, p<0.001). Stratified by their GMLE1 scores students who pursued electives abroad during their PY achieved higher GMLE2 scores (p<0.001). The strongest predictor for GMLE2 scores were grades obtained during medical school training; age and study duration indicated lower scores; and those engaging in international health electives correlated with higher scores. Conclusions: Students with higher GMLE1 scores go abroad during PY more often. Beyond that, students who pursue international health electives achieve higher GMLE2 scores than those who stay in Germany during PY. There is an unmet need for additional research to identify which factors make these students perform better and what motivates them to go abroad.

Background: High school completion provides health and economic benefits. The purpose of this study is to describe dropout rates based on longitudinal trajectories of aggression and study skills using teacher ratings., Methods: The sample consisted of 620 randomly selected sixth graders. Every year from Grade 6 to 12, a teacher completed a nationally normed behavioral rating scale. We used latent class mixture modeling to identify the trajectories., Results: Participants followed 3 trajectories of aggression (Low, Medium Desisting, and High Desisting) and 5 trajectories of study skills (Low, Average-Low, Decreasing, Increasing, and High). Over three-quarters of the sample were in stable trajectories of study skills over time. Most students in the High Desisting Aggression group were in the Low Study Skills group, and all students in the High Study Skills group were in the Low Aggression group. The overall dropout rate was 17%, but varied dramatically across combined aggression and study skills groups, ranging from 2% to 50%., Conclusions: The results highlight the importance of early prevention that combines academic enhancement and behavioral management for reducing school dropout., (© 2018, American School Health Association.)

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: The American Board of Surgery In-Training Examination (ABSITE) is used by programs to evaluate the knowledge and readiness of trainees to sit for the general surgery qualifying examination. It is often used as a tool for resident promotion and may be used by fellowship programs to evaluate candidates. Burnout has been associated with job performance and satisfaction; however, its presence and effects on surgical trainees' performance are not well studied. We sought to understand factors including burnout and study habits that may contribute to performance on the ABSITE examination., Methods: Anonymous electronic surveys were distributed to all residents at 10 surgical residency programs (n = 326). Questions included demographics as well as study habits, career interests, residency characteristics, and burnout scores using the Oldenburg Burnout Inventory, which assesses burnout because of both exhaustion and disengagement. These surveys were then linked to the individual's 2016 ABSITE and United States Medical Licensing Examination (USMLE) step 1 and 2 scores provided by the programs to determine factors associated with successful ABSITE performance., Results: In total, 48% (n = 157) of the residents completed the survey. Of those completing the survey, 48 (31%) scored in the highest ABSITE quartile (≥75th percentile) and 109 (69%) scored less than the 75th percentile. In univariate analyses, those in the highest ABSITE quartile had significantly higher USMLE step 1 and step 2 scores (P < 0.001), significantly lower burnout scores (disengagement, P < 0.01; exhaustion, P < 0.04), and held opinions that the ABSITE was important for improving their surgical knowledge (P < 0.01). They also read more frequently to prepare for the ABSITE (P < 0.001), had more disciplined study habits (P < 0.001), were more likely to study at the hospital or other public settings (e.g., library, coffee shop compared with at home; P < 0.04), and used active rather than passive study strategies (P < 0.04). Gender, marital status, having children, and debt burden had no correlation with examination success. Backward stepwise multiple regression analysis identified the following independent predictors of ABSITE scores: study location (P < 0.0001), frequency of reading (P = 0.0001), Oldenburg Burnout Inventory exhaustion (P = 0.02), and USMLE step 1 and 2 scores (P = 0.007 and 0.0001, respectively)., Conclusions: Residents who perform higher on the ABSITE have a regular study schedule throughout the year, report less burnout because of exhaustion, study away from home, and have shown success in prior standardized tests. Further study is needed to determine the effects of burnout on clinical duties, career advancement, and satisfaction., (Copyright © 2017 Elsevier Inc. All rights reserved.)

The outcomes of assistive technology (AT) support services for post-secondary education students with disabilities are under-reported, and little is known about use-profiles and user experiences when AT interventions are applied to this rapidly growing population. We examined AT service outcomes related to performance and satisfaction of common academic tasks (using the Canadian Occupational Performance Measure [COPM]), as well as how students with disabilities use and experience AT and AT services (employing an AT-use survey). Three-hundred fifty-three students with disabilities completed the AT-use survey, with a subset of these (n = 216) also participating with pre-post AT intervention COPM assessment. COPM performance and satisfaction ratings significantly increased from pre- to post-AT intervention in all academic task categories (reading, writing, note-taking, test-taking, and studying; p < 0.001). The AT-use survey most notably revealed these students preferred face-to-face training, used their AT at least 3 days per week, used AT in a variety of environments, felt AT positively impacted their academic success, and believed they would continue using AT post-graduation. The study findings contribute to evidence-base for AT services with a hope we may improve AT services to best meet the changing needs of the growing number of college students with disabilities.

Your department has had a good track record over many years for preparing trainees to successfully sit for the ACEM Fellowship exam. On average the pass rate for your trainees is over 80%. Then, to your dismay, suddenly only two of five of your trainees pass the latest Fellowship exam. Does this anomaly necessitate an urgent review of your department's training programme, or is it just a statistical quirk? Let us suppose you can prepare candidates so that they all have at least an 80% chance of passing. The probability that all five candidates would have passed is 32.8% (or 0.8 5 ) based on the multiplication rule of probability for independent events. The probability that only two of five passed is 5.1% (or 10 × 0.8 2 × 0.2 3 ) based on the binomial distribution, which is a probability distribution analogous to the normal distribution. The construction of the binomial distribution depends on two parameters: (i) number of candidates sitting ('n'), and (ii) probability of passing for any individual candidate ('P'). The distribution gives the probability that 'x' number of individuals will pass when 'n' number of individuals sit. Thus despite an 80% pass rate historically, the probability that only two of five candidates will pass is not negligible at 5.1%. It is an anomaly, which we may choose not to act on unless it is recurrent, noting it will be expected to occur naturally about one time out of 20. The real challenge is to maintain or increase that individual probability at 80% or higher., (© 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.)

Many factors influence the way individual students study, including but not limited to: previous coursework, attitudes toward the class (motivation, intimidation, risk, etc.), metacognition, and work schedules. However, little of this research has involved medical students. The present article asks the question, "Do individual medical students study differently for different classes?" Study skills surveys were given to United States medical students at an allopathic medical school and an osteopathic medical school. Students were surveyed near the end of their first year gross anatomy course and again near the end of their first year physiology course. Survey items included Likert scale and open-ended questions about study habits and basic demographic information. The survey responses were correlated with each student's final grade percentages in the courses. Analysis revealed that the four most common study habits were reviewing lecture notes, taking practice examinations, completing learning exercises, and making drawings and diagrams. The two surveys (anatomy and physiology) from each individual were also compared to see if students reported different study habits in anatomy versus physiology. A negative correlation was found between changing study habits between courses and final anatomy grade percentages. Additional analyses suggest that those students who do change their study habits between courses are increasing the number of study strategies that they attempt. This increase in the number of study strategies attempted may not allow the student to reach the same depth of understanding as their colleagues who utilize fewer strategies., (© 2015 American Association of Anatomists.)

Objective: Sufficient teaching and assessing clinical skills in the undergraduate setting becomes more and more important. In a surgical skills-lab course at the Medical University of Innsbruck fourth year students were teached with DOPS (direct observation of procedural skills). We analyzed whether DOPS worked or not in this setting, which performance levels could be reached compared to tutor teaching (one tutor, 5 students) and which curricular side effects could be observed., Methods: In a prospective randomized trial in summer 2013 (April - June) four competence-level-based skills were teached in small groups during one week: surgical abdominal examination, urethral catheterization (phantom), rectal-digital examination (phantom), handling of central venous catheters. Group A was teached with DOPS, group B with a classical tutor system. Both groups underwent an OSCE (objective structured clinical examination) for assessment. 193 students were included in the study. Altogether 756 OSCE´s were carried out, 209 (27,6%) in the DOPS- and 547 (72,3%) in the tutor-group., Results: Both groups reached high performance levels. In the first month there was a statistically significant difference (p<0,05) in performance of 95% positive OSCE items in the DOPS-group versus 88% in the tutor group. In the following months the performance rates showed no difference anymore and came to 90% in both groups. In practical skills the analysis revealed a high correspondence between positive DOPS (92,4%) and OSCE (90,8%) results., Discussion: As shown by our data DOPS furnish high performance of clinical skills and work well in the undergraduate setting. Due to the high correspondence of DOPS and OSCE results DOPS should be considered as preferred assessment tool in a students skills-lab. The approximation of performance-rates within the months after initial superiority of DOPS could be explained by an interaction between DOPS and tutor system: DOPS elements seem to have improved tutoring and performance rates as well. DOPS in students 'skills-lab afford structured feedback and assessment without increased personnel and financial resources compared to classic small group training., Conclusion: In summary, this study shows that DOPS represent an efficient method in teaching clinical skills. Their effects on didactic culture reach beyond the positive influence of performance rates.

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.

Purpose: Factor analysis is a useful technique to aid in organizing multivariate data characterizing speech, language, and auditory abilities. However, knowledge of the limitations of factor analysis is essential for proper interpretation of results. The present study used simulated test scores to illustrate some characteristics of factor analysis., Method: Linear models were used to simulate test scores that were determined by multiple latent variables. These simulated test scores were evaluated with principal components analysis and, in certain cases, structural equation modeling. In addition, a subset of simulated individuals characterized by poor test performance was examined., Results: The number of factors recovered and their identity do not necessarily correspond to the structure of the latent variables that generated the test scores. The first principal component may represent variance from multiple uncorrelated sources. Practices such as correction or control for general cognitive ability may produce misleading results., Conclusions: Inferences from the results of factor analysis should be primarily about the structure of test batteries rather than the structure of human mental abilities. Researchers and clinicians should consider multiple sources of evidence to evaluate hypotheses about the processes generating test results.

This retrospective descriptive correlational study compared the predictive accuracy of the Health Education Systems, Inc, Exit Exam (Elsevier) and Assessment Technologies Institute's RN Comprehensive Predictor, both of which were administered to nursing students in an upper-division baccalaureate nursing program during their final semester of study. Using logistic regression analyses, it was determined that the two examinations were statistically significant but weak predictors of success on the RN licensure examination. The RN Comprehensive Predictor had a slightly better odds ratio; however, both examinations had similar sensitivity, specificity, and overall accuracy. Because the RN Comprehensive Predictor was included in the Assessment Technologies Institute's Comprehensive Assessment and Review Program already being used by the BSN program, based on the results of this study, the nursing faculty decided to use only the RN Comprehensive Predictor during its NCLEX-RN preparation course.

Background: About 15% of medical students perform poorly in examinations. This study was done to ascertain the causes for low performance and the effectiveness of counselling and advice regarding study skills in improving performance in a subsequent assessment., Methods: Of the 353 students who appeared for the first internal assessment examination in pathology, 83 (23.5%) scored less than 30% marks. These 83 low-performers were given a questionnaire listing stress-inducing factors and academic problems; 81 filled the questionnaire. Of these, 73 attended sessions on study skills and counselling where they interacted on a one-to-one basis regarding their personal problems. Their performance was evaluated in an internal assessment 6 months later., Results: The low-performers included 52 boys and 29 girls, 19-20 years of age. Non-academic problems contributing to low performance included language problems, problems in adjustment to life outside home, lack of self-confidence, fear of failure and worrying about the future. Academic problems included difficulty in managing study time, lack of concentration while studying, inability to retain what is studied, anxiety before examinations and inability to write an examination. Paired t-test revealed a statistically significant improvement in the post-programme performance of the 73 students who participated in the counselling sessions (p<0.001), while that of the 10 who did not participate in the project, showed no statistically significant difference (p=0.54, Wilcoxon signed rank test). A majority of students felt that the sessions helped to improve their performance (average score 3.83/6.00), change their study behaviour (3.74/6.00) and change their attitude (3.46/6.00). The programme also improved their confidence and self-esteem., Conclusion: Low-performers can benefit from tailored remedial programmes which include counselling and training in stress-coping strategies., (Copyright 2012, NMJI.)

Although longitudinal designs are the only way in which age changes can be directly observed, a recurrent criticism involves to what extent retest effects may downwardly bias estimates of true age-related cognitive change. Considerable attention has been given to the problem of retest effects within mixed effects models that include separate parameters for longitudinal change over time (usually specified as a function of age) and for the impact of retest (specified as a function of number of exposures). Because time (i.e., intervals between assessment) and number of exposures are highly correlated (and are perfectly correlated in equal interval designs) in most longitudinal studies, the separation of effects of within-person change from effects of retest gains is only possible given certain assumptions (e.g., age convergence). To the extent that cross-sectional and longitudinal effects of age differ, obtained estimates of aging and retest may not be informative. The current simulation study investigated the recovery of within-person change (i.e., aging) and retest effects from repeated cognitive testing as a function of number of waves, age range at baseline, and size and direction of age-cohort differences on the intercept and age slope in age-based models of change. Significant bias and Type I error rates in the estimated effects of retest were observed when these convergence assumptions were not met. These simulation results suggest that retest effects may not be distinguishable from effects of aging-related change and age-cohort differences in typical long-term traditional longitudinal designs.

Test-taking behaviors (i.e., task focus, maintenance of attention, and cooperation) affect children's cognitive test performance, and, thus, it is critical to take test-taking behavior into account when drawing conclusions and making recommendations. Prior studies have evaluated test-taking behaviors at the end of the assessment; the present study focused on the fluctuation of cooperation and attention during a neuropsychological assessment. We examined the attention and cooperation of 5-year-old children in a test-taking situation; the associations between these aspects of their test-taking behavior and the children's concurrent neurocognitive test performance, IQ, and parent-rated behavior; and the associations with their IQ, behavioral outcomes, and academic achievement at 8 years of age. The data (for 76 boys and 63 girls) were drawn from the Jyväskylä Longitudinal Study of Dyslexia (Lyytinen et al., 2001, 2004). All the children were Caucasian and spoke Finnish as their native language. As a whole, the 5-year-old children showed high cooperation and attention, but a slight decrement in test-taking behavior toward the end of the session was rather common. Three subgroups of children with different levels of cooperation and attention were identified. Children in the subgroup with nonoptimal attention and cooperation showed decreasing neurocognitive test performance toward the end of the assessment session. They also showed more inattentive behavior 3 years later. The findings imply that the examiner's observations of waning attention and cooperation during the assessment session are highly relevant, as these provide stable and clinically meaningful information about the child's behavioral tendencies.