Medical Knowledge Assessment Research Articles

Transient Ischemic Attack

This issue provides a clinical overview of transient ischemic attack focusing on prevention, diagnosis, treatment, practice improvement, and patient information. Readers can complete the accompanying CME quiz for 1.5 credits. Only ACP members and individual subscribers can access the electronic features of In the Clinic. Non-subscribers who wish to access this issue of In the Clinic can elect "Pay for View." Subscribers can receive 1.5 category 1 CME credits by completing the CME quiz that accompanies this issue of In the Clinic. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including PIER (Physicians' Information and Education Resource) and MKSAP (Medical Knowledge and Self Assessment Program). Annals of Internal Medicine editors develop In the Clinic from these primary sources in collaboration with the ACP's Medical Education and Publishing division and with assistance of science writers and physician writers. Editorial consultants from PIER and MKSAP provide expert review of the content. Readers who are interested in these primary resources for more detail can consult www.acponline.org, http://pier.acponline.org, and other resources referenced within each issue of In the Clinic.

Atrial Fibrillation

This issue provides a clinical overview of atrial fibrillation focusing on prevention, diagnosis, treatment, practice improvement, and patient information. Readers can complete the accompanying CME quiz for 1.5 credits. Only ACP members and individual subscribers can access the electronic features of In the Clinic. Non-subscribers who wish to access this issue of In the Clinic can elect "Pay for View." Subscribers can receive 1.5 category 1 CME credits by completing the CME quiz that accompanies this issue of In the Clinic. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including PIER (Physicians' Information and Education Resource) and MKSAP (Medical Knowledge and Self Assessment Program). Annals of Internal Medicine editors develop In the Clinic from these primary sources in collaboration with the ACP's Medical Education and Publishing division and with assistance of science writers and physician writers. Editorial consultants from PIER and MKSAP provide expert review of the content. Readers who are interested in these primary resources for more detail can consult www.acponline.org, http://pier.acponline.org, and other resources referenced within each issue of In the Clinic.

Safety science meets basic science in problem-based learning

Context and setting Medical educators are continually challenged to add new topics to the curriculum. Calls for teaching about medical error and the science of improving patient safety come from multiple accrediting and credentialing bodies, as well as patient advocacy groups. Medical educators are faced with the challenge of how and where to begin teaching the scope of the issue, the necessary vocabulary and the ‘basic science’ of system improvement amidst an overcrowded curriculum. The second year of basic science at the College of Human Medicine, Michigan State University is delivered using a problem-based learning (PBL) curriculum. Organised in 10 organ or system domains, patient cases integrate basic science content and are supplemented by references, stimulus questions, and some lectures and laboratory sessions. Why the idea was necessary There is consensus that the teaching and assessment of medical error and patient safety knowledge, skills and attitudes should begin as early as possible so that learners are ready to apply these principles to their clinical experiences. Licensing organisations are adding questions on these topics to their examinations. The patient cases in our PBL curriculum have already provided the context for ethics, evidence-based medicine and other topics, the content of which is relevant to multiple PBL domains. Using these cases to provide context for medical error and patient safety-related content seemed logical. What was done Since 2008, the Cardiovascular Domain Curriculum Development Group (CDG) has added foundational material on medical error and patient safety science to several patient cases. An introductory lecture in the first week of the domain covered the scope of the issue, basic principles of error genesis, failure mode effect analysis, human factor engineering and root cause analysis (RCA). A pre-test of 10 multiple-choice questions preceded the lecture. Hospital patient safety goals (relating to communication error, medication reconciliation, health care-associated infection) guided the interpolation of medical errors into the existing cases. One ‘patient’ died as a result of a hand-off error. Stimulus questions for small-group discussion were added to cases with error and references were provided for independent study. On the last day of the domain, small groups watched a mock RCA. Five of the pre-test questions were placed on the final domain examination. Evaluation of results and impact Overall performance on the domain examination did not differ from that in previous years. For the five questions that appeared in both the pre-test and the domain examination, the mean student score was 50% in the pre-test and 79% in the domain examination. Mean student rating of the lecture was 3.6/5.0. Subsequently, a Year 3 student commented: ‘At the time I was not sure why we were learning this. We did an RCA on one of my patients this [clerkship] year … I knew what they were talking about and why it was done.’ One faculty member commented: ‘Thanks for adding this important material.’ The addition of foundational medical error and patient safety material to a PBL domain placed this material into a patient context, in which it was well received. Students demonstrated improvement in their knowledge base. Results were presented to our curriculum committee and a decision was made to add medical error and patient safety material to cases in every one of the PBL domains.

Clostridium difficileInfection

This issue provides a clinical overview of Clostridium difficile infection focusing on prevention, diagnosis, treatment, practice improvement, and patient information. Readers can complete the accompanying CME quiz for 1.5 credits. Only ACP members and individual subscribers can access the electronic features of In the Clinic. Non-subscribers who wish to access this issue of In the Clinic can elect "Pay for View." Subscribers can receive 1.5 category 1 CME credits by completing the CME quiz that accompanies this issue of In the Clinic. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including PIER (Physicians' Information and Education Resource) and MKSAP (Medical Knowledge and Self Assessment Program). Annals of Internal Medicine editors develop In the Clinic from these primary sources in collaboration with the ACP's Medical Education and Publishing division and with assistance of science writers and physician writers. Editorial consultants from PIER and MKSAP provide expert review of the content. Readers who are interested in these primary resources for more detail can consult www.acponline.org, http://pier.acponline.org, and other resources referenced within each issue of In the Clinic.

An Electronic Orthopaedic In-Training Examination

Following nearly 1 year of development, trials, surveys, and educational programs, in November 2009, the orthopaedic in-training examination (OITE) was successfully converted from the traditional print format and administered by DVD-ROM on local computers to more than 4,300 residents in 20 countries. A resident survey indicated a high level of satisfaction with the new examination. Questions with video and multislice image formats, presented as trial questions, performed well. Future versions of the OITE on DVD-ROM will eliminate some of the few difficulties experienced in 2009. The new electronic format offers excellent possibilities for improved imaging, the development of new and innovative questions, and an enhanced ability to approximate the practice environment-all of which can result in a better assessment of orthopaedic medical knowledge and an improved educational experience.

A blended approach to invasive bedside procedural instruction

Objective: This study assessed the impact of a blended, standardized curriculum for invasive bedside procedural training on medical knowledge and technical skills for Internal Medicine residents.Methods: The investigators developed a curriculum in procedural instruction and performance for Internal Medicine house staff, and implemented the program at a tertiary care academic medical center with a primary affiliation with a US medical school. The investigators chose procedures recommended for technical competence by the American Board of Internal Medicine: lumbar puncture, thoracentesis, paracentesis, central venous catheter insertion, and knee arthrocentesis. The program included: (1) assessment of baseline medical knowledge and technical proficiency on mannequins, (2) video instruction of procedure, (3) faculty-led discussion of critical concepts, (4) faculty demonstration of the procedure on mannequin, (5) individual practice on simulators, (6) post-intervention knowledge evaluation, and (7) post-intervention skills evaluation. The performance achieved during the initial skills evaluation on a mannequin was compared to the performance achieved on the first patient subsequent to the instructional portion.Results: All participants with complete data demonstrated a statistically significant pre-intervention to post-intervention improvement (p < 0.05) in comprehensive medical knowledge and procedural skills.Conclusion: A blended, standardized curriculum in invasive bedside procedural instruction can significantly improve performance in participants’ medical knowledge and technical skills.

Creighton University School of Medicine

Creighton University School of Medicine

Dyslipidemia

This issue provides a clinical overview of dyslipidemia focusing on prevention, diagnosis, treatment, practice improvement, and patient information. Readers can complete the accompanying CME quiz for 1.5 credits. Only ACP members and individual subscribers can access the electronic features of In the Clinic. Non-subscribers who wish to access this issue of In the Clinic can elect "Pay for View." Subscribers can receive 1.5 category 1 CME credits by completing the CME quiz that accompanies this issue of In the Clinic. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including PIER (Physicians' Information and Education Resource) and MKSAP (Medical Knowledge and Self Assessment Program). Annals of Internal Medicine editors develop In the Clinic from these primary sources in collaboration with the ACP's Medical Education and Publishing division and with assistance of science writers and physician writers. Editorial consultants from PIER and MKSAP provide expert review of the content. Readers who are interested in these primary resources for more detail can consult www.acponline.org, http://pier.acponline.org, and other resources referenced within each issue of In the Clinic.

Measuring learning gain during a one-day introductory bronchoscopy course.

BackgroundRigorous assessment of medical knowledge and technical skill inspires learning, reinforces confidence, and reassures the public. Identifying curricular effectiveness using objective measures of learning is therefore crucial for competency-oriented program development in a learner-centric educational environment. The aim of this study was to determine whether various measures of learning, including class-average normalized gain, can be used to assess the effectiveness of a one-day introductory bronchoscopy course curriculum.MethodsWe conducted a quasi-experimental one-group pre-test/post-test study at the University of California, Irvine. The group comprised 24 first-year pulmonary and critical care trainees from eight training institutions in southern California. Class-average normalized gain, single-student normalized gain, absolute gain, and relative gain were used as objective measures of cognitive knowledge and bronchoscopy technical skill learning. A class-average normalized gain of 30% was used to determine curricular effectiveness. Perceived educational value using Likert-scale surveys and post-course questionnaires was determined during and 3 months after course participation.ResultsMean test scores of cognitive knowledge improved significantly from 48 to 66% (p = 0.043). Absolute gain for the class was 18%, relative gain was 37%, class average normalized gain 〈g〉 was 34%, and the average of the single-student normalized gains g(ave) was 29%. Mean test scores of technical skill improved significantly from 43 to 77% (p = 0.017). Absolute gain was 34%, relative gain was 78%, class average normalized gain 〈g〉 was 60%, and the average of the single-student normalized gains g(ave) was 59%. Statistically significant improvements in absolute gain were noted in all five elements of technical skill (p < 0.05). Likert-scale surveys, questionnaires, and surveys demonstrated strong perceived educational value.ConclusionThe effectiveness of a one-day introductory bronchoscopy curriculum was demonstrated using a pre-test/post-test model with calculation of normalized gain and related metrics.Electronic supplementary materialThe online version of this article (doi:10.1007/s00464-010-1161-4) contains supplementary material, which is available to authorized users.

Heart Failure

This issue provides a clinical overview of heart failure focusing on prevention, diagnosis, treatment, practice improvement, and patient information. Readers can complete the accompanying CME quiz for 1.5 credits. Only ACP members and individual subscribers can access the electronic features of In the Clinic. Non-subscribers who wish to access this issue of In the Clinic can elect Pay for View. Subscribers can receive 1.5 category 1 CME credits by completing the CME quiz that accompanies this issue of In the Clinic. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including PIER (Physicians' Information and Education Resource) and MKSAP (Medical Knowledge and Self Assessment Program). Annals of Internal Medicine editors develop In the Clinic from these primary sources in collaboration with the ACP's Medical Education and Publishing division and with assistance of science writers and physician writers. Editorial consultants from PIER and MKSAP provide expert review of the content. Readers who are interested in these primary resources for more detail can consult www.acponline.org, http://pier.acponline.org, and other resources referenced within each issue of In the Clinic.

Depression

This issue provides a clinical overview of depression focusing on prevention, diagnosis, treatment, practice improvement, and patient information. Readers can complete the accompanying CME quiz for 1.5 credits. Only ACP members and individual subscribers can access the electronic features of In the Clinic. Non-subscribers who wish to access this issue of In the Clinic can elect "Pay for View." Subscribers can receive 1.5 category 1 CME credits by completing the CME quiz that accompanies this issue of In the Clinic. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including PIER (Physicians' Information and Education Resource) and MKSAP (Medical Knowledge and Self Assessment Program). Annals of Internal Medicine editors develop In the Clinic from these primary sources in collaboration with the ACP's Medical Education and Publishing division and with assistance of science writers and physician writers. Editorial consultants from PIER and MKSAP provide expert review of the content. Readers who are interested in these primary resources for more detail can consult www.acponline.org, http://pier.acponline.org, and other resources referenced within each issue of In the Clinic.

Gout

This issue provides a clinical overview of gout focusing on prevention, diagnosis, treatment, practice improvement, and patient information. Readers can complete the accompanying CME quiz for 1.5 credits. Only ACP members and individual subscribers can access the electronic features of In the Clinic. Non-subscribers who wish to access this issue of In the Clinic can elect "Pay for View." Subscribers can receive 1.5 category 1 CME credits by completing the CME quiz that accompanies this issue of In the Clinic. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including PIER (Physicians' Information and Education Resource) and MKSAP (Medical Knowledge and Self Assessment Program). Annals of Internal Medicine editors develop In the Clinic from these primary sources in collaboration with the ACP's Medical Education and Publishing division and with assistance of science writers and physician writers. Editorial consultants from PIER and MKSAP provide expert review of the content. Readers who are interested in these primary resources for more detail can consult www.acponline.org, http://pier.acponline.org, and other resources referenced within each issue of In the Clinic.

Development, Implementation, and Results of the ASN In-Training Examination for Fellows

The American Society of Nephrology and the fellowship training program directors in conjunction with the National Board of Medical Examiners developed a comprehensive assessment of medical knowledge for nephrology fellows in-training. This in-training examination (ITE) consisted of 150 multiple-choice items covering 11 broad content areas in a blueprint similar to the American Board of Internal Medicine certifying examination for nephrology. Questions consisted of case vignettes to simulate real-life clinical experience. The first examination was given in April 2009 to 682 fellows and six training program directors. Examinees felt that the examination was well structured and relevant to their training experience Longitudinal performance on the examination will be helpful in allowing training programs to utilize results from content areas in identifying deficits in medical knowledge as well as assessing the results of any curriculum changes.

Hypothyroidism

The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including PIER (Physicians' Information and Education Resource) and MKSAP (Medical Knowledge and Self Assessment Program). Annals of Internal Medicine editors develop In the Clinic from these primary sources in collaboration with the ACP's Medical Education and Publishing division and with assistance of science writers and physician writers. Editorial consultants from PIER and MKSAP provide expert review of the content. Readers who are interested in these primary resources for more detail can consult www.acponline.org, http://pier.acponline.org, and other resources referenced within each issue of In the Clinic.

Components of Critical Decision Making and ABSITE Assessment: Toward a More Comprehensive Evaluation

Accurate assessment of resident competency is a fundamental requisite to assure the training of physicians is adequate. In surgical disciplines, structured tests as well as ongoing evaluation by faculty are used for evaluating resident competency. Although structured tests evaluate content knowledge, faculty ratings are a better measure of how that knowledge is applied to real-world problems. In this study, we sought to explore the performance of surgical residents in a simulation exercise (strategic management simulations [SMS]) as an objective surrogate of real-world performance. Forty surgical residents participated in the SMS simulation that entailed decision making in a real-world-oriented task situation. The task requirements enable the assessment of decision making along several parameters of thinking under both crisis and noncrisis situations. Performance attributes include "simpler" measures of competency (activity level), intermediate categories (information management and emergency responses) to complex measures (breadth of approach and strategy). Scores obtained in the SMS were compared with the scores obtained on the American Board of Surgery In-Training Examination (ABSITE). The data were intercorrelated and subjected to a multiple regression analysis with ABSITE as the dependent variable and simulation scores as independent variables. Using a 1-tail test analysis, only 3 simulation variables correlated with performance on ABSITE at the .01 level (ie, basic activity, focused activity, task orientation). Other simulation variables showed no meaningful relationships to ABSITE scores at all. The more complex real-world-oriented decision-making parameters on SMS did not correlate with ABSITE scores. We believe that techniques such as the SMS, which focus on critical thinking, complement assessment of medical knowledge using ABSITE. The SMS technique provides an accurate measure of real-world performance and provides objective validation of faculty ratings.

A Web-Based Assessment of Pediatrics Resident Medical Knowledge in Childhood Hereditary Gastrointestinal Cancer Predisposing Syndromes

Pediatricians need to competently care for children with hereditary gastrointestinal cancer-predisposing syndromes. Pediatrics resident education on this subject has hithertofore never been studied. Forty-five US pediatrics/internal medicine-pediatrics program directors allowed their residents to participate in an anonymous questionnaire. The survey-questionnaire was administered as a hyperlinked interactive Web page through e-mail to all consenting residents. Thirty-eight sites including 290 of 1327 residents (21.5%) and 33 internal medicine-pediatrics participated in the study. Knowledge on polyposis syndromes varied by syndrome (14% to 84% correct) but not by year of training. Internal medicine-pediatrics residents were more likely to inquire on family history including polyposis, early colorectal cancer, than pediatrics residents. This study suggests that familiarity with cancer syndromes does not accrue during resident training in pediatrics. The observations suggest that greater emphasis on resident education on these syndromes may improve outcomes in this vulnerable group.

102: Does Correlation of Faculty Assessment of Emergency Medicine Residents' Medical Knowledge Competency With Performance on the In-Training Examination Improve With Advancement Through the Program?

Faculty assessment of emergency medicine (EM) residents on the medical knowledge (MK) core competency may or may not be predictive of performance on the annual in-training examination. We sought to determine if a greater degree of faculty exposure and experience with EM residents, as determined by PGY level, improved the correlation of the faculty's assessment of MK on quarterly summative evaluations with the score received on the EM in-training examination taken during the same time period.

Nephrolithiasis

This issue provides a clinical overview of nephrolithiasis focusing on prevention, diagnosis, treatment, practice improvement, and patient information. Readers can complete the accompanying CME quiz for 1.5 credits. Only ACP members and individual subscribers can access the electronic features of In the Clinic. Non-subscribers who wish to access this issue of In the Clinic can elect "Pay for View." Subscribers can receive 1.5 category 1 CME credits by completing the CME quiz that accompanies this issue of In the Clinic. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including PIER (Physicians' Information and Education Resource) and MKSAP (Medical Knowledge and Self Assessment Program). Annals of Internal Medicine editors develop In the Clinic from these primary sources in collaboration with the ACP's Medical Education and Publishing division and with assistance of science writers and physician writers. Editorial consultants from PIER and MKSAP provide expert review of the content. Readers who are interested in these primary resources for more detail can consult www.acponline.org, http://pier.acponline.org, and other resources referenced within each issue of In the Clinic.

Tuberculosis

This issue provides a clinical overview of tuberculosis, focusing on prevention, diagnosis, treatment, practice improvement, and patient information. Readers can complete the accompanying CME quiz for 1.5 credits. Only ACP members and individual subscribers can access the electronic features of In the Clinic. Non-subscribers who wish to access this issue of In the Clinic can elect "Pay for View." Subscribers can receive 1.5 category 1 CME credits by completing the CME quiz that accompanies this issue of In the Clinic. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including PIER (Physicians' Information and Education Resource) and MKSAP (Medical Knowledge and Self Assessment Program). Annals of Internal Medicine editors develop In the Clinic from these primary sources in collaboration with the ACP's Medical Education and Publishing division and with assistance of science writers and physician writers. Editorial consultants from PIER and MKSAP provide expert review of the content. Readers who are interested in these primary resources for more detail can consult www.acponline.org, http://pier.acponline.org, and other resources referenced within each issue of In the Clinic.

Cellulitis and Soft-Tissue Infections

This issue provides a clinical overview of cellulitis and soft-tissue infections, focusing on prevention, diagnosis, treatment, practice improvement, and patient information. Readers can complete the accompanying CME quiz for 1.5 credits. Only ACP members and individual subscribers can access the electronic features of In the Clinic. Non-subscribers who wish to access this issue of In the Clinic can elect "Pay for View." Subscribers can receive 1.5 category 1 CME credits by completing the CME quiz that accompanies this issue of In the Clinic. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including PIER (Physicians' Information and Education Resource) and MKSAP (Medical Knowledge and Self Assessment Program). Annals of Internal Medicine editors develop In the Clinic from these primary sources in collaboration with the ACP's Medical Education and Publishing division and with assistance of science writers and physician writers. Editorial consultants from PIER and MKSAP provide expert review of the content. Readers who are interested in these primary resources for more detail can consult www.acponline.org, http://pier.acponline.org, and other resources referenced within each issue of In the Clinic.