Medical School Examinations Research Articles

A Pilot Study of Symptoms of Major Depressive Disorder in Medical Students at an Osteopathic Medical School Before and After High-Stakes Examinations.

Given the high prevalence of symptoms of major depressive disorder (MDD) in medical students, identifying factors that impact the development of such symptoms is important. Previous data suggest that medical students can experience symptoms of MDD after medical school exams. It is not known if medical students experience more symptoms of MDD directly before or after exams. The aim of the current study is to determine the prevalence of symptoms of MDD in first- and second-year medical students directly before and after high-stakes medical school examinations. Two anonymous surveys were sent via REDCap to first- and second-year medical students at the University of New England College of Osteopathic Medicine. A pre-exam survey on the day of the exam asking about the past three days' MDD symptoms, and a post-exam survey sent three days after the exam asking about MDD symptoms experienced after the exam was sent out to a total of 391 students with a response rate of 23%. First- and second-year medical students regardless of gender experienced symptoms of MDD at higher rates before exams than afterwards. Female students experienced symptoms of MDD (as defined by the DSM-5) including sadness, sleep disturbances, and feelings of guilt or worthlessness at a greater rate compared to males before exams. After exams, females were more likely to experience sleep disturbances and decreased energy. Second-year male students were the least likely to experience symptoms of MDD. First- and second-year medical students can experience symptoms of MDD surrounding exams. This study highlights the emotional burden that students may carry near exams. It underscores the importance of further research on this topic to evaluate the effect exams have on the mental health of medical students during their training.

How does current paediatrics residency selection criteria correlate with residency performance?

The selection process for potential residents needs to be reviewed regularly and assessed if effective in selecting the best-fit residents who can achieve academic and professional excellence. Objective measures must take precedence over subjective criteria to reduce selection bias while ensuring transparency and accountability. However, the predictors of an ideal resident and his/her performance during residency training have been a great challenge to identify as part of the selection process. The use of examination results from medical school examination, licensing examinations such as the United States Medical Licensing Examination,1,2,3 and structured interviews4 was reported to correlate positively with doctor’s performances. A Canadian study also reported that the presence of scholarly activity did not affect match outcome, though this is variable for different programmes.5 Competitive programmes like paediatrics have a vested interest in selecting the most suitable applicants who will excel as paediatric residents and emerge as holistic, high-performing paediatricians in their field.6

Urology boot camp for medical students: Using virtual technology to enhance undergraduate education.

The study aims to describe the methodology of converting the urology boot camp for medical students into a virtual course with key take home points for a successful conversion and to present quantitative and qualitative data demonstrating the impact of the boot camp on improving delegates' knowledge and clinical acumen. The face-to-face boot camp was converted to a virtual format employing a variety of techniques including; utilizing an online platform to deliver live screened lectures, using online polling software to foster an interactive learning environment and displaying pre-recorded videos to teach practical skills. Validated Multiple Choice Questionnaires (MCQs) were used prior to and after the course. This enabled the assessment of delegates' knowledge of urology according to the national undergraduate curriculum, and paired t tests were used to quantify the level of improvement. Thematic analysis was carried out on post-course delegate feedback to identify highlights of the course and ways of improving future iterations. In total, 131 delegates took part in the pilot virtual course. Of these, 105 delegates completed the pre- and post-course MCQs. There was a statistically significant improvement in the assessment following the course (p= <0.001) with mean score increasing from 47.5% pre-course to 65.8% post-course. All delegates who attended the most recent implementation of the virtual course (n= 31) felt it improved their knowledge and confidence in urology. Twenty delegates (64.5%) felt that it prepared them for both final year medical school examinations and working as a foundation year doctor. Positive themes in feedback were identified, which included the interactive nature of the course, the quality of teaching, the level and content of information provided and the high yield, concise organization of the teaching schedule. Using virtual technology and innovative educational frameworks, we have demonstrated the successful conversion of the urology boot camp for medical students to a virtual format. At a national level, with support from the British Association of Urological Surgeons, the face-to-face component of the course will continue to run in parallel with the virtual course with the aim of standardizing and improving UK undergraduate urological education. The virtual course has been implemented on an international scale, and this has already shown promising results.

Quadruplets: Risks, Outcomes and a Set of Four/Twin Research Reviews and a Lawsuit: Antenatal Corticosteroids and Twins’ Neonatal Outcomes; Fathers of Twins; Doppelgängers and Similarity; Monozygotic Co-Twin Difference in Asymmetric Pigmented Paravenous Chorioretinal Atrophy/In the News: Opposite-Sex Twin Holocaust Survivors; Twin Models at Gucci; Twins With Different Fathers; Reunited Twins Enter Same Convent; Death of a Twin Soldier During Training;

Quadruplets are at elevated physical risks at prenatal, perinatal, and postnatal levels, relative to twins. A brief review of this area is followed by discussion of a female quadruplet with three co-quadruplet brothers. Next, several timely twin research reports are examined. The topics include antenatal corticosteroids and twins' neonatal outcomes, the meaning of fatherhood in families with twins, what doppelgängers (look-alikes) reveal about physical and behavioral similarity, and monozygotic (MZ) co-twin discordance for asymmetric pigmented paravenous chorioretinal atrophy. A lawsuit involving alleged cheating on a medical school examination by identical twins is also reviewed. General interest stories cover opposite-sex twin Holocaust survivors, twin models at a Gucci fashion show, twins with different fathers, reunited female twins who entered the same convent, the death of an MZ female twin soldier during training, and the surgical separation of conjoined twins in Brazil.

Screening for familial hypercholesterolaemia in primary school children: protocol for a cross-sectional, feasibility study in Luxembourg city (EARLIE)

IntroductionFamilial hypercholesterolaemia (FH) is a frequent (1:300) autosomal dominantly inherited condition which causes premature (women <60 years, men <55 years) cardio–cerebrovascular disease (CVD). Early detection and initiation of treatment can...

College competitiveness and medical school exam performance

BackgroundIn medical school, students are tested through periodic USMLE Step 1 and 2 examinations before obtaining a medical license. Traditional predictors of medical school performance include MCAT scores, undergraduate grades, and undergraduate institutional selectivity. Prior studies indicate that admissions committees might unfairly discriminate against applicants who graduated from less competitive universities. However, there is limited literature to determine whether those who attended competitive colleges perform better on USMLE Step 1 and 2 examinations.ObjectiveThe purpose of our study is to determine if students who attended competitive undergraduate colleges outperform those who did not on medical school benchmarks.MethodsWe defined a Competitive College as having greater than 10% of its student body scoring 1400 or higher (on a 1600 scale) on the SAT. If this criteria was not met, colleges would be categorized as Non-Competitive. Descriptive statistics and unpaired t-tests were calculated to analyze average test scores on the MCAT, Phase 1 NBME, USMLE Step 1, Phase 2 NBME, and USMLE Step 2.ResultsOur findings suggest there are no statistically significant differences between students who do or do not attend competitive undergraduate colleges on these medical school benchmark examinations following the MCAT.ConclusionAdmissions committees should use this data to aid in their student selection as our research indicates that institutional selectivity accurately predicts MCAT scores, but not performance on standardized medical school examinations once admitted.

SP2.1.6Virtual Work Experience: A Novel Method for Aspiring Doctors

AimsCurrent COVID-19 restrictions have limited face to face exposure of prospective medical students to the hospital environment. We aimed to deliver a virtual work experience event for secondary school pupils to understand the opportunities offered in a medical career.MethodsWe designed an event based upon a chronological progression from medical school to consultancy. Sessions included individual career experiences, the patient journey, a virtual hospital tour, simulated medical school interviews and examination preparation. The event was advertised by direct contact with secondary schools through phone and email, the local hospital trust communications department, and social media. Individuals registered online and were invited to submit targeted questions they would like covered during the session. The free one day event was delivered using online video conferencing software. Pre and post event feedback was obtained.Results771 registrations were received from 108 schools in the UK. In addition, the event attracted 26 individuals from India, Dubai, Thailand and the Philippines.73% of candidates had not attended any prior face to face work experience. Confidence levels of over 4 out of 5 on a visual analogue scale, with respect to the medical school application and interview process, improved from 11% to 81%. 99% of candidates would recommend the course to others and attend future events.ConclusionsCOVID-19 has disrupted the training of potential medical students. We designed and delivered a novel method of work experience at an international level. Encouraging feedback will pave the way for future iterations.

Assessment of factual recall and higher-order cognitive domains in an open-book medical school examination

Open-book examinations (OBEs) will likely become increasingly important assessment tools. We investigated how access to open-book resources affected questions testing factual recall, which might be easy to look-up, versus questions testing higher-order cognitive domains. Few studies have investigated OBEs using modern Internet resources or as summative assessments. We compared performance on an examination conducted as a traditional closed-book exam (CBE) in 2019 (N = 320) and a remote OBE with free access to Internet resources in 2020 (N = 337) due to COVID-19. This summative, end-of-year assessment focused on basic science for second-year medical students. We categorized questions by Bloom’s taxonomy (‘Remember’, versus ‘Understand/Apply’). We predicted higher performance on the OBE, driven by higher performance on ‘Remember’ questions. We used an item-centric analysis by using performance per item over all examinees as the outcome variable in logistic regression, with terms ‘Open-Book, ‘Bloom Category’ and their interaction. Performance was higher on OBE questions than CBE questions (OR 2.2, 95% CI: 2.14–2.39), and higher on ‘Remember’ than ‘Understand/Apply’ questions (OR 1.13, 95% CI: 1.09–1.19). The difference in performance between ‘Remember’ and ‘Understand/Apply’ questions was greater in the OBE than the CBE (‘Open-Book’ * ‘Bloom Category’ interaction: OR 1.2, 95% CI: 1.19–1.37). Access to open-book resources had a greater effect on performance on factual recall questions than higher-order questions, though performance was higher in the OBE overall. OBE design must consider how searching for information affects performance, particularly on questions measuring different domains of knowledge.

The motives, academic performance, and career prospects of Gazan medical students abroad: a cross-sectional study

BackgroundIn Gaza, 2 million people have been affected by more than 13 years of strict land, air, and sea blockades and three wars, during which over 4000 people have been killed and many more have been injured. Additional severe effects have been seen on lives, aspirations, and prospects. Given the conditions, medical students have many competing reasons for and against studying medicine abroad. We investigated motives, academic situations, and future plans of the upcoming generation of doctors in Gaza, occupied Palestinian territory. MethodsWe did a questionnaire-based cross-sectional study involving Palestinian medical students originally from Gaza who were studying at the largest five medical schools in Egypt (Cairo, Ain Shams, Alexandria, Mansoura, and Zagazig Universities). We used a self-designed questionnaire developed from previous similar studies and created on Google Forms (Google, Menlo Park, CA, USA). A pilot study of 37 participants was done to test the comprehensibility of questions and the time needed to complete the questionnaire. After being updated, the questionnaire was distributed in August and September, 2018, to individuals who provided verbal informed decision to participate. Analysis of the results was performed with SPSS version 22. FindingsOf 453 questionnaires given to students, 340 (75%) were returned completed. The mean age of respondents was 21·7 (SD 1·8) years; 225 (66%) were men and 115 (34%) were women. Excellence was achieved in secondary school examinations (result ≥90%) by 315 (93%) of students, but only 26 (8%) of students achieved excellence in their first year of medical school (examination results ≥85%). 317 students (93%) reported that they chose their medical schools independently without pressure from their families. Among the 115 women, 70 (61%) went to a third party to persuade their parents to allow them to study abroad. Of ten motives to study medicine given in the questionnaire, “to relieve pains” and “childhood dream” were the most frequently selected among the 340 respondents, chosen by 228 (67%) and 208 (61%), respectively. 104 (31%) reported they were seeking freedom more than to study medicine. 214 (63%) of students had at least one relative who had been physically injured in or killed during of one of the wars in Gaza. Most students (n=278 [82%]) were delayed from starting at their medical school due to border closures and 189 (56%) had been unable to attend for at least one semester. Since starting at medical school, 269 (79%) of 340 respondents had visited Gaza only once or not at all. 55 (16%) intended never return to Gaza and 209 (62%) reported that they wanted to specialise and work abroad for a period and then return to Gaza. Of the remainder, 64 (19%) wanted to specialise abroad then return to work in Gaza, and 12 (3%) wanted to specialise and work in Gaza. InterpretationThe motives, academic performance, and career prospects of Gazan medical students studying in Egypt are influenced in many ways by the situation in Gaza, some of which could worsen the already bad condition of medical care in Gaza. Awareness and supportive programmes for Gazan medical students should be encouraged to improve the quality of health care providers in Gaza. FundingNone.

Barriers and facilitators to writing quality items for medical school assessments \u2013 a scoping review

BackgroundProducing a sufficient quantity of quality items for use in medical school examinations is a continuing challenge in medical education. We conducted this scoping review to identify barriers and facilitators to writing good quality items and note gaps in the literature that are yet to be addressed.MethodsWe conducted searches of three databases (ERIC, Medline and Scopus) as well as Google Scholar for empirical studies on the barriers and facilitators for writing good quality items for medical school examinations.ResultsThe initial search yielded 1997 articles. After applying pre-determined criteria, 13 articles were selected for the scoping review. Included studies could be broadly categorised into studies that attempted to directly investigate the barriers and facilitators and studies that provided implicit evidence. Key findings were that faculty development and quality assurance were facilitators of good quality item writing while barriers at both an individual and institutional level include motivation, time constraints and scheduling.ConclusionsAlthough studies identified factors that may improve or negatively impact on the quality of items written by faculty and clinicians, there was limited research investigating the barriers and facilitators for individual item writers. Investigating these challenges could lead to more targeted and effective interventions to improve both the quality and quantity of assessment items.

School-based oral health education increases caries inequalities.

To evaluate the effect of one and half years of an oral health promotion program in primary schools. A cluster-randomized controlled trial. 740 students aged 9-12 years (48% female) recruited from the fifth grade of 18 different primary schools in West Pomerania, Germany. General and oral health education was provided to the teachers in the intervention schools, which they conveyed to their students. No additional measures were conducted in the control schools. Medical and dental school examinations, as well as questionnaires for the students and their parents were conducted at baseline and follow-up. Data were analysed using Poisson regression models. A significant incident rate ratio between caries increment was found, with a 35% higher risk in the control group. However, parents' socioeconomic characteristics modified the effect of the program on their children, as high socio-economic status in the intervention group was associated with 94% reduction in the incidence risk ratio (p ⟨ 0.001). The program was effective in improving dental health among students with higher socio-economic status. No preventive effect could be found in low socio-economic status groups.

Progress on a New Kind of Progress Test: Assessing Medical Students’ Clinical Skills

Progress testing of medical knowledge has advantages over traditional medical school examination strategies. However, little is known about its use in assessing medical students' clinical skills or their integration of clinical skills with necessary science knowledge. The authors previously reported on the feasibility of the Progress Clinical Skills Examination (PCSE), piloted with a group of early learners. This subsequent pilot test studied the exam's validity to determine whether the PCSE is sensitive to the growth in students' clinical skills across the four years of medical school. In 2014, 38 medical student volunteers (years 1-4) in the traditional 2 + 2 curriculum at Michigan State University College of Human Medicine participated in the eight-station PCSE. Faculty and standardized patients assessed students' clinical skills, and faculty assessed students' responses to postencounter necessary science questions. Students performed pretest self-assessment across multiple measures and completed a posttest evaluation of their PCSE experience. Student performance generally increased by year in medical school for communication, history-taking, and physical examination skills. Necessary science knowledge increased substantially from first-year to second-year students, with less change thereafter. Students felt the PCSE was a fair test of their clinical skills and provided an opportunity to demonstrate their understanding of the related necessary science. The authors have been piloting a wider pool of cases. In 2016, they adopted the PCSE as part of the summative assessment strategy for the medical school's new integrated four-year curriculum. Continued assessment of student performance trajectories is planned.

Disabled graduate-entry medical student experience.

This study explored the experiences of graduate-entry medicine degree programme students who were disabled on the disclosure of their disability and the challenging disability issues they encountered during their degree programme. Eight student volunteers with a disability from the University of Warwick graduate-entry medicine degree programme took part in this study. Audio recordings of their semi-structured interviews were transcribed verbatim and analysed thematically. Contributory factors to a reluctance or delay in disclosing disability to the medical school included confidentiality concerns, the potential impact of disclosure on their medical school application outcome and not perceiving their disability had an impact on their ability to function. They disclosed their disability for a range of professional and practical considerations. One participant was investigated and diagnosed with dyslexia following failure in a medical school examination. Disabled medical students encountered challenging issues such as having concerns about their future fitness to practice and employability, repeated disclosure of disability, confidentiality, abuse and difficulties in organising reasonable adjustments. Disabled medical students encounter challenging issues DISCUSSION: Medical school staff should keep an open mind about undiagnosed disability as a potential contributory factor to graduate students' academic underperformance. Participants expressed concerns about the management of their disability information that could potentially be addressed through regular dialogue between the students with a disability and medical school representatives, to define who, when and how other staff members could have access to the students' disability information. Despite the challenges students with a disability encountered during their degree programme, they viewed themselves as individuals who were in a good position to empathise with patients and understand their needs.

The Prevalence of Item Construction Flaws in Medical School Examinations and Innovative Recommendations for Improvement

The purpose of this study was to calculate the prevalence and nature of item construction flaws within one large medical school and to identify several innovative approaches that may serve as potential remedies for these problems. Results indicated that approximately one in five items contained a construction flaw, with the overwhelming majority of flaws involving poor quality distractors. A series of innovative recommendations are presented, including modern psychometric analytical techniques to more thoroughly inspect data, item manipulation techniques, and the use of innovative item types that may alleviate the need for distractors altogether.

Using the Spearman-Brown Prophecy Formula to Improve Medical School Examination Quality

Most measurement experts suggest a minimum reliability estimate of .60 to .70 is desirable for routine medical education assessments with low to moderate stakes. The most common recommendation for improving examination reliability is to increase examination length. Unfortunately, adjustments in examination length may result in unpredictable reliability estimation and involve a great deal of trial and error for educators. The Spearman-Brown prophecy formula may help medical educators accurately predict the effects of adding or removing items on reliability estimation, and help educators make immediate improvements to the psychometric quality and functioning of their examinations.

Does Timing of Internal Medicine Residency Interview Affect Likelihood of Matching?

Applicants to our internal medicine (IM) residency program consistently have shared concerns about whether the interview date influences their ability to match via the National Residency Matching Program. We performed a retrospective study to assess whether interview timing was associated with successful matching at our IM program. We identified all of the applicants who interviewed for a first-year position with our IM residency program from 2010 to 2014. Each year's interview dates were totaled and divided equally into three categories: early, middle, or late. Baseline demographics, United States Medical Licensing Examination scores, and type of medical school (American or international) were compared among the interview date groups and between those who did and did not match at our program. Of 914 interviewees, 311 interviewed early (October/November), 299 interviewed in the middle (December), and 304 interviewed late (January). The proportion to match at our program was similar in each interview group (12.5%, 18.4%, 15.1%, respectively; P = 0.133). Logistic regression analysis showed that the middle interview group had increased odds to match compared with the early group (odds ratio 1.590; P = 0.044). The late-versus-early group showed no difference (P = 0.362). No significant differences were found with type of medical school or United States Medical Licensing Examination scores. Of all of the interviewees participating in the match, nearly all matched into a program somewhere, with no significant difference based on interview timing. When considering all of the interviewees, interview date showed no major influence on matching. Only the middle interview time period showed a slight increased chance of matching to our IM program, but the significance was marginal.

Bland–White–Garland syndrome diagnosed by computed tomography

A seven year old girl was referred to our pediatric clinic with an abnormal cardiac murmur found during her school medical examination. She was asymptomatic. It was diagnosed as a functional murmur but transthoracic echocardiography (TTE) revealed enlarged left main trunk (LMT) (4.8 mm) and right coronary artery (RCA) (5.8 mm) (Fig. 1). Kawasaki disease was suspected and she was referred to our hospital for an invasive coronary angiogram. She and her family opted first for non invasive imaging by electrocardiogram gated 320 slice CT. In CT acquisition, triple phase contrast material injection was performed using 40 ml of iodinated contrast material (300 mgI/ml) followed by 20 ml saline to enhance left (highly enhanced) and right (slightly enhanced) heart to simultaneously examine the coronary arteries and detect any other congenital heart disease. We used 240, instead of the full 320, detector rows to reduce radiation exposure. Tube voltage was 100 kV and tube current was set at 200 mV. Despite administration of β-blockers, her heart rate (HR) only decreased to 70 beats per minute (bpm). To image her heart, we used a HeartNAVI® system (Toshiba), with a temporal resolution that can be optimized according to the HR during scanning. CT images are usually reconstructed using data from 2 heart beats for subjects with HR's from 66 to 79 bpm. We amended this procedure to reduce radiation exposure; retrospective ECG acquisition was performed with tube current modulation using data from only one heartbeat. CT images were reconstructed every 5% from 0 to 95% of the RR interval. We assessed images using data from all 20 phases and the best optimal phase images were selected manually (Figs. 2–6). On CT, an enlarged RCA with several well-developed, abnormal septal branches were observed (Figs. 2, 4, 5). Also the LMT originated from the pulmonary trunk (PT) (Figs. 3, 5) and blood flow from LMT to PT (Fig. 6) could be observed.

Exam Success at Undergraduate and Graduate-Entry Medical Schools: Is Learning Style or Learning Approach More Important? A Critical Review Exploring Links Between Academic Success, Learning Styles, and Learning Approaches Among School-Leaver Entry (“Traditional”) and Graduate-Entry (“Nontraditional”) Medical Students

Phenomenon: The literature on learning styles over many years has been replete with debate and disagreement. Researchers have yet to elucidate exactly which underlying constructs are measured by the many learning styles questionnaires available. Some academics question whether learning styles exist at all. When it comes to establishing the value of learning styles for medical students, a further issue emerges. The demographics of medical students in the United Kingdom have changed in recent years, so past studies may not be applicable to students today. We wanted to answer a very simple, practical question: what can the literature on learning styles tell us that we can use to help today's medical students succeed academically at medical school? Approach: We conducted a literature review to synthesise the available evidence on how two different aspects of learning—the way in which students like to receive information in a learning environment (termed learning “styles”) and the motivations that drive their learning (termed learning “approaches”)—can impact on medical students' academic achievement. Findings: Our review confirms that although learning “styles” do not correlate with exam performance, learning “approaches” do: those with “strategic” and “deep” approaches to learning (i.e., motivated to do well and motivated to learn deeply respectively) perform consistently better in medical school examinations. Changes in medical school entrant demographics in the past decade have not altered these correlations. Optimistically, our review reveals that students' learning approaches can change and more adaptive approaches may be learned. Insights: For educators wishing to help medical students succeed academically, current evidence demonstrates that helping students develop their own positive learning approach using “growth mind-set” is a more effective (and more feasible) than attempting to alter students' learning styles. This conclusion holds true for both “traditional” and graduate-entry medical students.

Balancing Test Length with Sufficiently Reliable Scores

One of the most important indicators of a quality examination is the reliability of the scores. In low to moderate stakes scenarios it is desirable for scores to achieve a minimum estimate of .70. Unfortunately, for many medical educators it is difficult to attain this minimum threshold for “acceptable” statistical reproducibility. A common approach is to include additional items to an exam, but this process can become cumbersome and misguided without clear direction. Fortunately, the Spearman-Brown Prophecy formula can help medical educators identify approximately how many additional items will be necessary to achieve a minimum reliability estimate of .70. This article describes a case in which we were presented with a less than desirable reliability estimate from a previous medical school examination, utilized the Spearman-Brown Prophecy formula, and was able to achieve the minimum estimate of .70 on the next iteration of the examination. We encourage others to make use of this technique rarely utilized outside of the psychometric arena as well.

AN ANOMALOUS LEFT CORONARY ARTERY BRANCHING OFF THE PULMONARY ARTERY (BLAND-WHITE-GARLAND SYNDROME) DIAGNOSED BY 320 DETECTOR ROWS COMPUTED TOMOGRAPHY

If enlarged coronary arteries are observed in infants, we must first differentiate between Kawasaki disease, and arteritis. A seven year old girl was referred to our hospital with an abnormal cardiac murmur found at her school medical examination. It was diagnosed as a functional murmur but a