National Board Examinations Research Articles

Skepticism About Loss of Skepticism!-Reply

In Reply. — We welcome Dr Prichard's constructive critique of our editorial 1 calling for reform of the medical curriculum and the National Board examinations. It is our hope that the ensuing dialogue will represent one of the first steps toward correcting what we see as serious problems and deficiencies in the current system. We would be the first to admit that there are no hard data to cite for either side in this debate. Our editorial was based on observations made during many years of teaching at our respective medical schools. It may well be that the first step in reforming medical education in the United States should be the collection of some objective information on which to base recommendations concerning the content of the proposed new curriculum for American medical education in the 21st century. However, such information is not easily obtained or quantified. How does one measure

Skepticism About Loss of Skepticism!

To the Editor.— Alpert and Coles 1 started their December editorial, Loss of Skepticism in Medical Education, with the ... pathology Professor's favorite words—How do you know that? This pathology professor would like to ask them the same thing regarding their claim that the school curriculum is hostage to the national board examination. Their polemic provides neither evidence of that claim nor evidence that they know what the National Board of Medical Examiners (NBME) is up to. They also claim, without citing evidence, that medical students must know much more today than in the past. They think this imagined need to know more makes examinations a less relevant means of assessing ability because the need to memorize facts for the NBME adversely affects the development of critical thinking. In the matter of content to be learned, it is easy to forget that as new material is added to the curriculum

Skepticism about loss of skepticism!

To the Editor.— Alpert and Coles 1 started their December editorial, "Loss of Skepticism in Medical Education," with the "... pathology Professor's favorite words—How do you know that?" This pathology professor would like to ask them the same thing regarding their claim that the "medical school curriculum is hostage to the national board examination." Their polemic provides neither evidence of that claim nor evidence that they know what the National Board of Medical Examiners (NBME) is up to. They also claim, without citing evidence, that medical students must know much more today than in the past. They think this imagined need to know more makes examinations a less relevant means of assessing ability because the need to memorize facts for the NBME adversely affects the development of critical thinking. In the matter of content to be learned, it is easy to forget that as new material is added to the curriculum

A Validity Study of Part III of the National Board Examination

The purpose of this study was to investigate the validity of Part III of the National Board Examination, a certifying examination of medical knowledge and patient management abilities. The subjects were 1,866 first-year resident physicians who graduated from Jefferson Medical College between 1970 and 1984. Statistically significant correlations were found between scores on this examination on the one hand and measures of basic and clinical sciences in medical school and Parts I and II of the National Board Examination on the other hand. Also, graduates who were rated high on supervisors' ratings of clinical competence areas in residency obtained higher scores on the examination than those rated low on this scale even when their baseline knowledge (scores on Part II) was controlled by employing analysis of covariance. In addition, assumptions were made that graduates who were offered further residency training and those who pursued broader, less-specialized careers would score higher on this examination. Both assumptions were confirmed. This 15-year study not only provides unique information about the validity of one certifying examination, but it also presents a model that might be used to evaluate other certification tests. Improvements in validity produced by new testing methods, such as computerized administration, could be put into perspective by using similar validity studies.

Effectiveness of a national board review course for dental students

In view of national concerns about student aptitude and overcrowded curricula, the effectiveness of review courses must be evaluated objectively. The present study is a statistical analysis of the impact of a review course on National Board Examination (NBE) Part I performance at the University of Detroit. The performance of dental students who had taken the course between 1985 and 1987 (N = 175) was compared to that of the prior three classes (N = 212). Analysis of covariance (ANCOVA) was used to adjust and compare mean scores on the NBE, using entering GPA and DAT scores, both measures of aptitude, as covariates. Only two of the five NBE scores demonstrated significant improvement. While aptitude contributed as much as 23 percent to NBE performance, the contribution of the review course was limited to 1.5 percent. The review course was most effective in areas that (1) were covered during the greatest number of terms, (2) were presented most recently, or (3) had the least number of topics on the NBE. This strategy for evaluating course effectiveness permits a dental school to easily assess the value of an NBE review course, as well as identify strengths and weaknesses in the curriculum.

Effects of academic and psychosocial predictors of performance in medical school on coefficients of determination.

This study was designed to answer the following questions: (1) Does a set of selected noncognitive variables predict medical school performance measures? (2) Is there a significant increase in the coefficients of determination when noncognitive measures are added to the conventional cognitive predictors in regression models? Complete data on all measures were available for 88 sophomore medical students. Cognitive (academic) predictors were undergraduate GPA in science and nonscience courses, and scores on science problems, reading and quantitative scales of the Medical College Admission Test. Noncognitive (psychological) predictors were scores on scales of stressful life events, general anxiety, test anxiety, emotionality, external locus of control, intensity and chronicity of loneliness, sociability, self-esteem, perception of early relationships with mother, father and peers, and indices of over- and underconfidence. Criterion measures were freshman and sophomore GPAs in medical school and scores on Part I of the National Board examinations. Results indicate that (1) noncognitive predictors could significantly predict criterion measures and (2) inclusion of noncognitive measures in a model of cognitive predictors could substantially increase the magnitude of the relationships.

The Selection of Residents-Reply

In Reply. —Dr Mindel has misstated some of my editorial remarks on the use of Part I National Board scores in the selection of residents. Nowhere does the editorial comment on the use by ophthalmology programs of Part I National Board scores; Dr McCollister does so in his article.1The intent of the editorial was to caution program directors and others about the limitations of Part I of the National Board examinations, not to advise program directors about their selection methods. Equally important, nowhere does the editorial make the claim that performance on Part I reflects academic achievement that can be related to the quality of later professional life. What was said was that academic achievement in general is held by conventional wisdom to relate to the quality of later professional life, ie, students who do well in high school do well in college, etc. The point being made

The Indigestible Curriculum

Pity the plight of the contemporary medical student: his or her curriculum holds more material than can be digested even by the most zealous of students. The technological and scientific knowledge explosion since World War II has deluged the medical student with an enormous learning burden. The volume of information that must be committed to memory in order to pass National Board Examinations is truly staggering, not to mention the intellectual gymnastics required to integrate and employ such knowledge in the daily practice of clinical medicine. 1 Is it any wonder that more and more of our medical students and junior house staff seek psychiatric support for troubled emotional lives, divorce, and substance abuse? Furthermore, professional fatigue or burn out is all too common in middle-aged physicians. 24 We contend that an important factor in the genesis of these adverse emotional states is the extraordinary pressure generated by the large

How to Evaluate Residents

In 1985, more than 75 000 residents were in more than 4700 accredited graduate medical education programs at 1500 institutions. Are competent physicians being produced? Outside of National Board and FLEX examinations (which may not tap actual clinical performance) and specialty board examinations (which are not obligatory), how do we know? This book may not answer this question explicitly, but it does delineate some options. The book's first part consists of selections from the proceedings of a conference of the same title held in Chicago in 1986. The second is a selection of previously published articles addressing the problem of resident evaluation in particular specialties. From the outset the editors do not suggest that the book be read from cover to cover. Rather, it is to be sampled selectively according to a reader's particular needs. It is a book intended for physicians involved in resident education. Thus, it would be

T-lymphocyte polyclonal proliferation: Effects of stress and stress response style on medical students taking national board examinations

This study investigated the effects of stress and stress response style on T-lymphocyte polyclonal proliferation (TLPP). The TLPP levels of 15 medical students taking NBME Part I were compared to those of a matched (on age and sex) sample of students not taking exams and hospital employees. All subjects completed the Impact of Events Scale to measure recent stress levels and style of responding to stress. TLPP data for both experimental and control groups, pre- and post-boards, were analyzed via a 2 × 2 factorial analysis of variance. Results indicated a singificant main effect for the NBME stress vs control conditions and a significant interaction between stress response style (avoidance vs intrusion) and NBME stress vs control conditions. TLPP levels were significantly depressed (relative to the controls) for the NBME stress group 1 week after examinations. Furthermore, those students whose stress response style was characterized by intrusion were significantly more immunosuppressed than those characterized by an avoidance stress response style. Four- and six-week follow-up measures of TLPP were taken on 10 and 11 NBME group students, respectively. Follow-up results, analyzed via t tests, indicated that TLPP levels were significantly suppressed for 4 weeks but returned to initial normal levels at 6 weeks. Results are discussed in terms of needed research examining the mechanism of stress intruders' susceptibility to stress-induced immunosuppression and the possible clinical significance of brief periods of stress-induced decrements in TLPP levels.

Use of objective examinations in medicine clerkships. Ten-year experience

Student performance during the internal medicine clerkship at the University of Washington School of Medicine has been evaluated by clinical ratings and a written examination containing multiple-choice questions and patient management problems for the past 10 years. Measures of the correlation among the evaluation methods were determined by analyzing data from 1,544 students. The correlations of clinical ratings with the total examination score (r = 0.27), multiplechoice questions (r = 0.23), and patient management problems (r = 0.19) suggest that clinical ratings alone are not adequate for measuring student progress. The relationships of evaluation methods used in the medicine clerkship to other measures of performance such as selection to Alpha Omega Alpha and National Board examinations were also determined. The ability to predict student performance was enhanced considerably when the results of the clerkship examination were considered in addition to clinical ratings. These data suggest that a comprehensive assessment of student performance in medicine clerkships should include written examinations in addition to clinical ratings.

Eponym's 's: Argyll Robinson, Not pseudo-Turner, Was e. e. cummings' endocrinologist

To the Editor.— As senior medical students interested in the history of medicine and in eponymic nomenclature, we read with great interest Dr Vaughan's 1 recent letter concerning the National Board of Medical Examiners' policy regarding the use of 's in eponymic designations. We disagree with Dr Vaughan's assertion that the nagging dilemma of correct and consistent usage of ' s is properly resolvable by categorical deletion. While this proposal may indeed be expedient for the editors, proofreaders, and typists of the National Board of Medical Examiners, we strongly oppose this deviation from standard English usage. Having endured numerous National Board examinations in recent years, we can attest to the fact that the loss of ' s is both jarring to the ear and clumsy on the tongue (eg, Crohn disease, Pott disease). Our foremost objection, however, lies in the blatant linguistic impropriety of this policy. Dr Vaughan states that the National

The use of national board scores in selecting residents for obstetrics and gynecology

The performance of 29 residents in obstetrics and gynecology on parts 1 and 2 of the national board examinations, which they had taken to graduate from medical school, was compared to their performance on the Council on Resident Education in Obstetrics and Gynecology in-training examination taken during the third year of residency. There was a statistically significant correlation between results of part 1 of the national board and results of the Council on Resident Education examination (r = 0.45, p < 0.05) and between part 2 of the national board and results of the Council on Resident Education examination (r = 0.67, p < 0.001). Those scoring “low” (less than fiftieth percentile) on the Council on Resident Education test all had scores <500 on part 2 of the national board, whereas those scoring “high” on the Council on Resident Education test (greater than ninetieth percentile) scored about 600 or higher on part 2 of the national board. These data suggest that results of part 2 of the national board can be useful in the resident selection process and that the performance of residents on in-training examinations relates more to resident selection than to the residency educational programs.

Anatomy

<b>Functional Human Anatomy</b>, by James E. Crouch, ed 4; 645 pp, with illus, $32.50, Philadelphia, Lea &amp; Febiger, 1985. <i>Anatomy</i>, by Ernest W. April, PhD, is one of a series of seven basic science books entitled the<i>National Medical Series for Independent Study</i>. It is designed to be a review for students preparing for various national board examinations as well as for course examinations. The book is a brief, basic presentation of regional and systemic anatomy, divided into nine parts and 34 chapters. Each part includes a number of study questions in national board format. The correct answers and a short explanation of each are provided. The outline format is acceptable if not always ideal. The text contains some functional anatomy, some clinical applications, and a little basic physiology. It seems to be well crossreferenced, and the index is quite detailed. The illustrations are good, but the reproduction does not

Analysis of the national board examination with regard to questions in emergency medicine

Analysis of the national board examination with regard to questions in emergency medicine

Comparison of dental students' academic performance using honors/pass/fail and letter grades

Performance in a second-year course in pedodontics/orthodontics for three classes of students at the State University of New York at Stony Brook School of Dental Medicine who received grades under an honors/pass/fail system was compared to that of three academically comparable classes that received letter grades. The average scores from the pedodontic/orthodontic section of the Part II National Board examination also were compared. The dental students taught under the letter grade system achieved a small but statistically significant higher grade point average in the dental course than the students taught under the honors/pass/fail system. The difference between the National Board scores was not statistically significant. It was concluded that while the letter grade system provided incentive for the students to perform at a higher level than those under the honors/pass/fail system, it did not influence their performance on the National Board examination.

On the Purpose and Quality of the National Board Examination of Medical Practice

On the Purpose and Quality of the National Board Examination of Medical Practice

Content Survey of Behavioral Sciences Courses

A survey of U.S. medical schools reveals an average of 133 hours scheduled for teaching of up to 110 different topics during the freshman and sophomore years in courses on behavioral sciences. There is only general correlation between what medical schools emphasize and what is evaluated in National Board Examinations, Part I.

Tutorial Teaching of Psychiatry: Effects on Test Scores, Attitudes, and Career Choices of Medical Students

A tutorial teaching program for medical students, previously found highly effective at Ohio State University (OSU), was adapted for use at the University of South Carolina (USC). Three classes of USC students obtained mean scores well above average on the psychiatry National Board Examination; at OSU a similar trend has persisted for seven consecutive years. Students also reported positive attitudes toward psychiatrists and psychiatry and entered psychiatry residency training at a rate higher than the national average. Tutorial teaching is effective for increasing cognitive knowledge, for promoting positive attitudes, and perhaps for increasing interest in psychiatry as a career choice.

Predictors of performance on National Board Examinations Part II

An effort was made to determine successful predictors of performance on National Board Examinations Part II. Preliminary results, using stepwise regression analysis, identified two predictor variables accounting for 65 percent of the variance in the criterion variable. Cross-validation regression analysis again identified the same two predictor variables accounting for 69 percent of the variance in the criterion variable. In both investigations, the correlation coefficients for the predicted National Board averages and the actual National Board averages are statistically significant. Implications of the studies are discussed.