Cumulative Assessment Research Articles

Cardiac Health Awareness Among Women Presenting for Routine Health Checkup at Tertiary Care Center: Time Trends Over 15 Years

Abstract Background Women have been thought to be protected against the perils of cardiovascular disease (CVD) till late in their lives. But the literature suggests quite the opposite with CVD being a major cause of death even in young women. In contrast, the lack of awareness among women is disheartening and needs to be addressed radically. Methods The study was designed and conducted as retrospective cohort at a tertiary care center. Data was collected from patients presenting for routine cardiac health checkup over the past 15 years. The parameters observed included age at presenting, symptoms and/or signs, plus area of residence or domicile. Results A total of 32,831 patients presented for routine cardiac health checkup, of which 9,211 (28.1%) patients were women and 23,620 (71.9%) were men. On 5 yearly cumulative assessment, the mean attendance of women was 28.1 ± 2.5% as compared with 71.9 ± 2.6% men. Trend observed over the past 15 years revealed little change in the number of women versus men presenting for cardiac health checkup annually. Statistical significance was seen at p < 0.01. Among the women presenting for the checkup, it was observed that most women were in the postmenopausal age group (42.8%), followed by perimenopausal age group (34.6%), and least in premenopausal age group (22.5%) during the timeline of the study. A similar trend was observed in the male attendance; the input of males being higher at all instances. Noteworthy were trends of urban women (69.6%) presenting for health checkup more often as compared with 30.4% visiting from rural residence. Conclusions Coronary artery disease (CAD) is not uncommon in female gender. It is accompanied by varying symptom presentation with high mortality. It is seen that cardiac health awareness is significantly lacking among women as compared with men. There are almost static trends observed over the past 15 years, especially in premenopausal age group and rural domicile. Corrective actions inclining toward campaigns and communication to distribute information on cardiac disease prevention and treatment modalities among women are needed to curb CAD. This may promote early detection of CAD leading to early interventions to promote a healthy heart among women. Recommendations and necessary actions steps for a woman oriented cardiac program are the need of the hour.

A national-scale cumulative exposure assessment of organophosphorus pesticides through dietary vegetable consumption in China

Using the data from the “Agro-product Quality and Safety Risk Monitoring Plan” of the Ministry of Agriculture of China between 2012 and 2016, acute and chronic risk assessments of cumulative exposure to organophosphorus pesticides (OPPs) through vegetable consumption were conducted. The concentrations of 19 OPPs were measured in a total of 75,655 vegetable samples from urban and rural sites located in 31 provinces and covering 95 vegetable raw agricultural commodities (RACs). The results showed that 4989 samples (6.59%) contained at least one OPP and that 615 samples (0.81%) contained various combinations of OPPs. From the multiexposure data, the cumulative exposure was estimated for 19 OPPs using an equivalence approach, where the contribution of each OPP was calculated according to its measured concentration and its relative potency factor (RPF) with respect to acetylcholinesterase (AChE) inhibition of the index compound methamidophos. The cumulative exposure levels of OPPs were compared across ten age and sex subpopulation groups of Chinese under lower boundary (LB) and upper boundary (UB) scenarios to handle left-censored residue data. The highest cumulative exposure level of OPPs was observed in the subpopulation of children aged 2–7 years under the UB scenario. The P99.9 and P97.5 exposure levels in different subpopulation groups under both LB and UB scenarios did not exceed the acute reference dose (ARfD) or chronic acceptable daily intake (ADI) of methamidophos, respectively. This study is the first to investigate the cumulative exposure of OPPs in relation to neurotoxic health risks in China on the national level.

Freshwater cumulative effects and environmental assessment in the Mackenzie Valley, Northwest Territories: challenges and decision-maker needs

ABSTRACTThere is a recognized need to advance cumulative effects assessment to regional and ecologically meaningful scales, but such initiatives are often critiqued for being isolated from management contexts and the regulatory practices of project-based environmental assessment. A major challenge is that there has been limited attention devoted to understanding decision-making at the project level, and the value of monitoring data to support cumulative effects analysis. This article examines how cumulative effects are considered during environmental assessment decision-making within the context of freshwater management in the Mackenzie Valley, Northwest Territories. Interviews with representatives from organizations involved in environmental assessment, regulation, and monitoring are used to identify challenges to applying information about cumulative effects at the project scale. Results reinforce the need for regional approaches and improvements in information and monitoring capacities to support cumulative effects analysis, but also the need to address institutional and organizational deficiencies to ensure that the data and information generated are useful to and applied within project-based decision-making.

Differential impact of anthropogenic pressures on Caspian Sea ecoregions

Over the past decades, overall ecological conditions in the Caspian Sea have deteriorated. However, a comprehensive understanding of lake-wide spatial differences in anthropogenic pressures is lacking and the biological consequences of human impacts are poorly understood. This paper therefore aims at assessing the individual and combined effects of critical anthropogenic pressures on the Caspian Sea ecoregions. First, cumulative pressure scores were calculated with a cumulative environmental assessment (CEA) analysis. Then, the individual contribution of anthropogenic pressures was quantified. Finally, ecoregion-specific differences were assessed. The analyses show that both cumulative and individual pressure scores are unevenly distributed across the Caspian Sea. The most important individual pressures are invasive species, chemical pollution and poaching. This uneven distribution of pressure scores across Caspian Sea ecoregions creates new challenges for future conservation strategies, as different ecoregions usually require different conservation measures.

All by myself? Meta-analysis of animal contests shows stronger support for self than for mutual assessment models.

Since the 1970's, models based on evolutionary game theory, such as war of attrition (WOA), energetic war of attrition (E-WOA), cumulative assessment model (CAM) and sequential assessment model (SAM), have been widely applied to understand how animals settle contests. Despite the important theoretical advances provided by these models, empirical evidence indicates that rules adopted by animals to settle contests vary among species. This stimulated recent discussions about the generality and applicability of models of contest. A meta-analysis may be helpful to answer questions such as: (i) is there a common contest rule to settle contests; (ii) do contest characteristics, such as the occurrence of physical contact during the fight, influence the use of specific contest rules; and (iii) is there a phylogenetic signal behind contest rules? To answer these questions, we gathered information on the relationship between contest duration and traits linked to contestants' resource holding potential (RHP) for randomly paired rivals and RHP-matched rivals. We also gathered behavioural data about contest escalation and RHP asymmetry. In contests between randomly paired rivals, we found a positive relationship between contest duration and loser RHP but did not find any pattern for winners. We also found a low phylogenetic signal and a similar response for species that fight with and without physical contact. In RHP-matched rivals, we found a positive relationship between contest duration and the mean RHP of the pair. Finally, we found a negative relation between contest escalation and RHP asymmetry, even though it was more variable than the other results. Our results thus indicate that rivals settle contests following the rules predicted by WOA and E-WOA in most species. However, we also found inconsistencies between the behaviours exhibited during contests and the assumptions of WOA models in most species. We discuss additional (and relatively untested) theoretical possibilities that may be explored to resolve the existing inconsistencies.

Self-assessment strategy during contest decisions between male Great Himalayan leaf-nosed bats

Agonistic interactions in animals are often settled based on the rules of an assessment strategy. We tested the predictions of evolutionary game theory models (including two models based on self-assessment: (a) the energetic war of attrition model, (b) the cumulative assessment model, and a third model (c) based on mutual assessment model) during contests between males of the Great Himalayan leaf-nosed bat Hipposideros armiger. We also studied the potential proxies of resource holding potential (RHP: body mass and forearm length) and their relationship to contest duration and the level of escalation. Overall, heavier males won more contests than lighter males, and they had an advantage in physical fights. In physical contests, the contest duration was positively correlated with the body mass of the loser but not the body mass of the winner. These results supported the prediction that males make decisions based on their own RHP (self-assessment: the energetic war of attrition model) rather than on RHP of their opponent (mutual assessment). Contest duration was not related to the forearm length of the winner or the loser. No relationship between body size (i.e., body mass and forearm length) and contest duration was observed for non-physical contests. This did not support any of the predictions applying to the energetic war of attrition model, the cumulative assessment model, and the mutual assessment model, indicating that no assessment occurred during non-physical contests. This study provides the first empirical evidence that bats make decisions based on their own RHP during agonistic interactions. This study provides empirical evidence supporting the hypothesis that during physical contests bats make decisions based on estimates of their own ability (self-assessment) rather than on a process of mutual assessment. This finding will facilitate comparative studies of fighting strategy across bat species.

Coil spring failure and fatigue analysis

This paper presents the failure and fatigue analysis results of a coil spring removed from a personal vehicle after having failed in service. Using experimental procedures like visual observations, optical and scanning electron microscopy, the failed coil was examined in order to determine the causes of the fracture. Furthermore, the chemical composition of the material was determined and a hardness test performed. It was concluded that the continuous contact between the coils formed corrosion pits that served as crack initiation points leading to the final fracture. Based on these findings, the finite element model of the coil spring was built to run the stress analysis under stochastic variable dynamic loading. The quarter car model was used for the assessment of vehicle behaviour under dynamic loading. Matlab numerical routine was used to perform rainflow counting as well as Miner's cumulative damage assessment in accordance with Goodman failure criterion. The obtained results give prediction of the spring fatigue life. The results can be useful in the further design optimization of motor vehicle coil springs.

Clerkship Curriculum Design and USMLE Step 2 Performance: Exploring the Impact of Self-Regulated Exam Preparation.

This study examined medical students' stress and certification exam preparation practices in a reformed clerkship curriculum that excluded high-stakes knowledge testing from end-of-rotation performance evaluation. Stress and exam preparation practices were assessed via a survey comprising locally developed questions, three subscales of the Motivated Strategies for Learning Questionnaire, and two subscales of the Medical Student Stressor Questionnaire. The association between stress, learning self-regulation, and certification exam scores was evaluated retrospectively using non-parametric tests of association (Spearman's rho). Forty students responded to the survey and consented to use of academic performance data (57% participation rate). Mean certification exam scores were indistinguishable from historical controls. Exam preparation practices resembled those of pre-clinical students: exam-related worrying and time devoted to studying were high, increasing as the exam drew near; preferred study resources were directly analogous to exam questions; and study involved relatively few generative strategies (e.g., concept mapping). Sustaining effort and creating time and space to study were associated with better exam performance, as was participation in this study. On the surface, the absence of regularly spaced, high-stakes testing from clerkship performance evaluation appears to "do no harm" to students' certification exam scores. Students already performing better academically may excel due in part to effective learning self-regulation strategies. However, a clerkship curriculum that does not scaffold self-regulation via cumulative knowledge assessment could further disadvantage students already earning lower scores. Evaluating the impact of curriculum reforms should continuously examine changes to learners' experience in context.

Analysing progress of sustainable development goal 6 in India: Past, present, and future

The attainment of sustainable development in water and sanitation i.e. Sustainable Development Goal 6 (SDG 6) requires a comprehensive monitoring and knowledge base of social and economic water needs at national scale in such a way that should not cause negative environmental manifestations from regional to global scale. India holds a key position among developing economies with a complex interconnected web of fast-growing population, coupled with biophysical stress, social deprivation and economic inequality related to utilization, availability and access to water resources and sanitation facilities. This study addresses some of these challenges related to monitoring and implementation of the targets of the UN SDG 6 in India. Acknowledging the contribution of society and economy in sustainability paradigm, here we have chosen 28 indicators (clustered into 11 dimensions) under two major groups, concerning biophysical and social development aspects of water and sanitation. We have shown declining level of per capita biophysical water resource and slow to rapidly developing societal indicators related to SDG 6 in India. From past trends, we have calculated probable scenario of biophysical consumption of India up to 2050. We have also analysed the interrelationship of water and sanitation (SDG 6) with health (SDG 3) and end to poverty (SDG 1) in India. These show a positive impact of increasing per capita GDP on improving sanitation related indicators, which in turn positively influence to reduce water and sanitation related diseases, especially in children and aged population. This cumulative assessment framework contributes a tool to prioritize water resource appropriation and assessment of sanitation, management response and policy implementations to national level inclusive sustainability of water and sanitation sector, keeping in mind the societal and economic development scenario in India.

Cumulative groundwater impact assessment and management in the Surat Basin: a journey from framework to implementation

The coal seam gas (CSG) industry in Queensland has expanded rapidly in the Surat and Bowen basins within this decade. Depressurisation for CSG production has the potential to affect overlying and underlying aquifers. This leads to wide-ranging stakeholder concerns around the groundwater impacts, particularly cumulative effects, because the coal seams are part of the Great Artesian Basin. Relatively early in the development cycle, Queensland set a framework whereby an area of intensive petroleum and gas development is proactively declared to be a cumulative management area. For such areas, the independent Office of Groundwater Impact Assessment (OGIA) undertakes cumulative impact assessment and prepares management arrangements that are reported through the underground water impact report. OGIA’s assessment through its iterative reporting–monitoring–modelling cycle has been providing the basis for managing and monitoring groundwater impacts on the ground and providing clarity in tenure holders’ responsibilities. OGIA has also built extensive knowledge of the groundwater systems and developed innovative modelling techniques over the years that have wider application elsewhere. This paper shares OGIA’s journey in the process.

Prediction of groundwater impacts from coal seam gas extraction in the Surat Basin

The Queensland regulatory framework recognises that the impacts of groundwater extraction activities can overlap in areas of concentrated development. Such areas of overlapping impacts can be declared ‘cumulative management areas’ (CMAs). When a CMA is established, the Office of Groundwater Impact Assessment (OGIA) becomes responsible for carrying out a cumulative impact assessment and preparing an Underground Water Impact Report (UWIR). The Surat CMA was declared in March 2011, and since this time, two iterations of the UWIR have been published in 2012 and 2016, underpinned by a gradually evolving regional groundwater flow model. This case study presentation will examine a number novel features of the regional groundwater flow model, resulting from OGIA’s ongoing research and development program, including the development of an adapted version of the MODFLOW-USG groundwater flow modelling code and approximation of coal desaturation and dual-phase flow effects using a modified van Genuchten function. The presentation will also look at the simulation of CSG extraction using a ‘descending drain’ methodology that recognises the gas-filled nature of CSG wells and generating up-scaled properties of highly heterogenous sedimentary material by first generating stochastic realisations of fragments of these layers, and then using ‘numerical permeameters’ to determine both the expected value and stochasticity of these properties, at the regional scale.

Synergies in the role of the Office of Groundwater Impact Assessment and the Independent Expert Scientific Committee on coal seam gas and large coal mining development in environmental assessments

The Independent Expert Scientific Committee on Coal Seam Gas and Large Coal Mining Development (IESC) is a statutory committee that provides scientific advice to Australian governments on the impacts that each coal seam gas (CSG) and large coal mining development may have on water resources. In this context, the IESC consider all aspects of a water resource, including water, organisms and ecosystems that contribute to or rely on them. The Office of Groundwater Impact Assessment (OGIA) is an independent statutory entity responsible for undertaking cumulative impact assessments from CSG and other petroleum production in Queensland, including the Surat Cumulative Management Area (CMA). OGIA also establishes impact management arrangements and identifies responsible tenure holders to implement specific aspects of those arrangements. Neither the IESC nor OGIA are regulators. Due to their respective functions both entities have different roles and interaction with CSG development in the Surat CMA. The IESC and OGIA engage regularly to ensure a shared understanding of knowledge, research and management. This paper provides an overview of key synergies between the roles and functions of the IESC and OGIA and considerations for proponents when using OGIA assessment in their environmental assessments that are referred to IESC for advice.

Critique of the Linear-Compensatory Approach in Customer Satisfaction Measurement: An Empirical Study

Purpose of the Study: The researchers critique the linear-compensatory combinatorial rule used in the expectancy-value model that is widely applied to explain how customers integrate attribute-level information in satisfaction judgements. Data/Methodology: The data have been collected from customers of an online travel agency. The surveys were administered via email, after their interaction with customer service advisor on telephone. The survey instrument is largely based on the SERVQUAL model, with a few additional items pertaining to the call centre context. A randomly selected sample of 626 usable responses was obtained based on completeness of data. As compared to the traditional methods, where a summary analysis of aggregated data is done, the present data analysis follows a deconstructive approach, involving assessing changes in degree of satisfaction brought about by change in each degree of performance for every quality attribute. Findings: By following a unique analytical approach to analysing survey data, the study classifies customer satisfaction as not unlike other evaluative judgements, such as morality and likableness, where summary evaluations are a result of a cumulative assessment of all attributes that constitute the particular context. Originality: This study explores the process of cognitive appraisal, which underlies the combination of varied service quality information, in the form of attributes of service quality into unitary satisfaction judgements.

Web-based process planning system concept selection using Weighted Decision Matrix and Analytical Hierarchy Process: A case study of sheet metal bending operations

Abstract The demand for sheet metal bending products has pushed the sheet metal industry to adopt new process planning approaches that can transform the existing systems in order to improve efficiency and reduce costs during product design and manufacture. Sheet metal industries are still using traditional system planning methods, which have limited capacity to respond to rapid changes in market requirements. In light of this, this paper proposes a suitable web-based process planning system that can be used to effectively bend varieties of sheet metal products using various bending press machines. Three web-based process planning system concepts were formulated in this study and evaluated using various criteria. The result of the Weighted Decision Matrix (WDM) and the Analytical Hierarchy Process (AHP) analyses revealed that web-based process planning system concept Y with a cumulative assessment score of 1.90 and a priority assessment score of 0.637 is the suitable web-based process planning system that could be used to effectively bend varieties of sheet metals. This evaluation approach serves as a useful information for system designers in other manufacturing sectors, to select suitable systems capable of effectively carrying out their operations.

Selecting mixtures on the basis of dietary exposure and hazard data: application to pesticide exposure in the European population in relation to steatosis.

Populations are exposed to mixtures of pesticides through their diet on a daily basis. The question of which substances should be assessed together remains a major challenge due to the complexity of the mixtures. In addition, the associated risk is difficult to characterise. The EuroMix project (European Test and Risk Assessment Strategies for Mixtures) has developed a strategy for mixture risk assessment. In particular, it has proposed a methodology that combines exposures and hazard information to identify relevant mixtures of chemicals belonging to any cumulative assessment group (CAG) to which the European population is exposed via food. For the purposes of this study, food consumption and pesticide residue data in food and drinking water were obtained from national surveys in nine European countries. Mixtures of pesticides were identified by a sparse non-negative matrix underestimation (SNMU) applied to the specific liver steatosis effect in children from 11 to 15 years of age, and in adults from 18 to 64 years of age in nine European countries. Exposures and mixtures of 144 pesticides were evaluated through four different scenarios: (1) chronic exposure with a merged concentration dataset in the adult population, (2) chronic exposure with country-specific concentration datasets in the adult population, (3) acute exposure with a merged concentration dataset in the adult population, and (4) chronic exposure with a merged concentration dataset in the paediatric population. The relative potency factors of each substance were calculated to express their potency relative to flusilazole, which was chosen as the reference compound. The selection of mixtures and the evaluation of exposures for each country were carried out using the Monte Carlo Risk Assessment (MCRA) software. Concerning chronic exposure, one mixture explained the largest proportion of the total variance for each country, while in acute exposure, several mixtures were often involved. The results showed that there were 15 main pesticides in the mixtures, with a high contribution of imazalil and dithiocarbamate. Since the concentrations provided by the different countries were merged in the scenario using merged concentration data, differences between countries result from differences in food consumption behaviours. These results support the approach that using merged concentration data to estimate exposures in Europe seems to be realistic, as foods are traded across European borders. The originality of the proposed approach was to start from a CAG and to integrate information from combined exposures to identify a refined list of mixtures with fewer components. As this approach was sensitive to the input data and required significant resources, efforts should continue regarding data collection and harmonisation among the different aspects within the pesticides regulatory framework, and to develop methods to group substances and mixtures to characterise the risk.

Peculiarities of high-risk pregnancy management after the IVF procedure: a clinical observation report

This article presents an annotation and discussion of our own clinical observation of a high-risk multiple pregnancy after in vitro fertilization in a patient with tuboperitoneal infertility. We report a case of early prenatal diagnosis of a rare malformation of a single fetus in dichorionic twin pregnancy (pentalogy of Cantrell). The feasibility of cumulative assessment of the risks of assisted reproductive technology complications to determine the tactics of management and intensive observation during pregnancy, as well as the use of invasive intrauterine interventions for multiple pregnancy to reduce perinatal risks is discussed.

Knowledge to decision in dynamic seas: Methods to incorporate non-indigenous species into cumulative impact assessments for maritime spatial planning

Incorporating ecosystem changes from non-indigenous species (NIS) is an important task of maritime spatial planning. Maritime spatial planning requires a framework that emphasises ecological functioning in a state of dynamic change, including changes to ecosystem services from functions introduced by new NIS. Adaptable modelling toolsets should be developed that can readily incorporate knowledge of new NIS. In the Baltic Sea, recent NIS examples are the North American mud crab Rhithropanopeus harrisii and the Ponto-Caspian round goby Neogobius melanostomus. We performed environmental niche modelling that predicted N. melanostomus will spread across large areas of the Baltic Sea coast while R. harrisii will be limited to regions with high temperature and low salinity conditions. We then performed a meta-analysis on literature showing effects in the Baltic Sea from these NIS and calculated the standardised effect-sizes on relevant ecosystem services. Half the impacts identified for N. melanostomus were considered to increase ecosystem service outcomes, while all R. harrisii impacts caused apparent decreases. Effect coefficients were incorporated into an online impact assessment tool developed by the Estonian Marine Institute. Users with or without science training can use the portal to estimate areas impacted and changes to natural assets (km2) caused by these NIS and cumulative effects from other pressure-types. Impact estimates are based on best available knowledge from manipulative and correlative experiments and thus form a link between science and management. Dynamic modelling techniques informed from varied ecological and methodological perspectives will effectively advise spatial planners about rapid maritime changes and mitigation actions to reduce NIS impacts especially in the focus areas.

Collaborative community development in mining regions: The Calama Plus and Creo Antofagasta programs in Chile

The mining industry is widely criticized for its corporate community development strategies, which led to accusations of greenwash and low social legitimacy. This problem identified led to the following research question: What model of community relations allows companies to generate shared value, in a broad sense, and create long-term relationships with communities? In order to answer the question posed, this paper explores the innovative experiences of the Calama Plus and Creo Antofagasta programs in the Antofagasta region of Chile. Calama Plus is an ongoing public-private program (2012–2025) established to combat declining standards of living in the city. Creo Antofagasta is also an ongoing public-private program (2013–2035), which is designed to confront the challenges of rapid growth in the city. Based on these two case studies, their underlying model (i.e., the collaborative community development model) was systematized for this study. The main innovative aspects of the model are its focus on the long-term, its concentration on territory- oriented projects, and its multi-stakeholder governance structure. The latter characteristic implies a collaboration between several companies and even between competitors. Drawing on a collaborative governance framework, the aim of this paper is to extensively describe the companies’ perspective on the following: the innovative aspects of the model, the drivers required for companies to participate, how companies can specifically contribute to these programs, and its critical management issues. New drivers and critical management issues are identified and discussed in this research, which represent a contribution to the collaborative governance framework.Since the Calama Plus and Creo Antofagasta programs’ focus is long-term, ending in 2025 and 2035 respectively, their impact has not been evaluated. For this reason, we include a discussion on the cumulative impact assessment perspective needed for these collaborative community development programs, placing particular attention on the controversial relationship between mining and local development. This approach is based on the assessment of cross-sector partnership results, its impact on the balance of social, environmental and economic capitals, and on the creation of broadly shared value in terms of long-term socio-economic capability building. Finally, policy implications and the potential for applying this model to other contexts are also discussed.

Cumulative assessment: Does it improve students’ knowledge acquisition and retention?

AIMS: Cumulative assessment has been used as a tool to steer students’ study behavior, since it increases students’ self-study time while spreading their study time more evenly throughout the span of the course. However, little is known about the impact of cumulative assessment on students’ knowledge growth. Therefore, our study compared the growth of knowledge of students who attended a course with cumulative assessment with those with end-of-course assessment. We hypothesized that students in the cumulative assessment condition would have a higher increase in knowledge compared to students in the end-of-course assessment condition.METHODS: This is a follow-up study of a previous randomized experiment that compared students’ performance between students who attended a course with cumulative assessment with those with end-of-course assessment. We gathered data of the first four subsequent Dutch interuniversity progress test after the experiment from 62 students. Of those, 37 students were in the end-of-course assessment condition and 25 were in the cumulative assessment condition. The questions were classified as part of the teaching block or not. To analyze students’ knowledge growth, we conducted a General Linear Model.RESULTS: Our results demonstrated that there was a significant increase in students’ knowledge of the four subsequent progress tests. Additionally, our general linear model showed no difference between both groups, indicating that cumulative assessment and end-of-course assessment produced similar outcomes when comparing students’ knowledge growth.CONCLUSIONS: So far, little evidence has supported the use of cumulative assessment as a tool for increasing students’ knowledge growth. The lack of finding a positive effect of cumulative assessment on knowledge retention may be explained by the repetitive character of our (spiral) curriculum.

Students as stakeholders in assessment: how students perceive the value of an assessment.

IntroductionFor 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.MethodsA 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.ResultsSeventy-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).DiscussionStudents 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.