Vignette Questions Research Articles

Comparing the Development in Medical Physiology Exam Design in the US and the UK

AIM: To discuss and contrast the recent development of medical physiology assessment between the UK and USA. HYPOTHESIS: The assessment trends set by the USA are regularly imported to the UK, but often the transplants do not take. DISCUSSION: Over the past twenty years educators in the UK have witnessed nominal improvements in medical exam writing policy. Much of this has been driven by American educational advances and theories. The main driver of this one-way trans-Atlantic progression is the larger student numbers in the USA. Until now, the UK has not had a national exam for qualifying newly graduating doctors. The new Medical Licensing Assessment (MLA), which will form the basis of national qualification, will begin to provide such a national test this year (2024) in the UK. Thus far, many USA trends in automated testing have been imported to the UK, but not always successfully. For example, in the early 2000s, nearly all medical schools in the UK instituted extended matching questions (EMQs) [1], but by the late 2000s, nearly all UK medical schools abandoned EMQs [2]. Starting in the late 2000s, single best answer (SBA) formats of 5-option MCQs became a requirement for exam writers. The idea was that high level thinking and judgment would be required to pick the best of the five plausible answers. Again, for post-graduate medical students in the USA, this fit well with diagnostic vignette questions, but for 18-year-old year 1 physiology students in the UK, who were still wrestling with factual knowledge, these judgment exams seemed over-ambitious. Yet, they were enforced upon exam writers. Another policy enforced was that questions could not be negatively phrased, as this has the potential to confuse students under pressure. Although this policy is well-intentioned, negative questions are essential for MCQs directly eliciting student's knowledge on symptoms and other ideas that cannot be reversed. For example, in the item, "What is a symptom of heart failure?" it is nearly impossible to write four plausible distractors, whereas, "All of the following are common symptoms of heart failure EXCEPT" could have "dehydration" as a correct negative answer. Finally, there is a current policy that SBA stems should be phrased so that a student should be able to propose the answer without seeing any of the options. This has been called "the cover test" because if the exam quality team cannot answer the question without seeing the options, the test item is rejected. This means that questions starting, "which of the following" are now rejected immediately. From the student perspective, this policy means that the process of selecting an answer from the list of options is transparent; the answer is recognised rather than weighing proposed options. But this makes it nearly impossible to ask questions about cause-and-effect relations where there are multiple related events such as, "Which of the following is a potential cause of high cardiac preload?" The supposed cover-test version would be, "What causes preload to increase?", which plainly is not a transparent question, as there are so many answers. CONCLUSION: The assessment processes that evolve in the USA are more suitable for the USA context than for the context in the UK. However, the UK educates very well using its home-grown processes. [1] George, S. (2003). Psychiatric Bulletin, 27(6), 230-232. [2] Eijsvogels, T. M., van den Brand, T. L., & Hopman, M. T. (2013). Perspectives on Medical Education, 2, 252-263. None. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Comparative Analysis of Multimodal Large Language Model Performance on Clinical Vignette Questions

This study compares 2 large language models and their performance vs that of competing open-source models.

An examination of questioning methods and the influence of child maltreatment on paediatric pain assessments: Perspectives of healthcare providers.

Children with a history of maltreatment have underestimated and undertreated pain; however, it is unknown if healthcare providers consider maltreatment when assessing children's pain. The current study aimed to address this issue by investigating healthcare providers' pain assessment practices, and specifically, their consideration of child maltreatment. Healthcare providers (N = 100) completed a survey, asking them to reflect upon their pediatric pain assessment practices (e.g., methods and questions used to assess pain) through self-report and case vignette questions. Participants who received continuing education about child maltreatment were more likely to consider maltreatment in several areas of their pediatric pain assessment practice, whereas participants who received continuing education about pediatric pain, were not. Participants were also more likely to report that they would consider maltreatment in vignette responses than in questions regarding their daily practice. Findings indicate healthcare providers use multidimensional methods when assessing children's pain, although it is unclear when or how they use open-ended vs. option posing questions. Healthcare providers also tended to consider the effects of child maltreatment on children's ability to communicate their pain more so when the history of maltreatment was known to them.

Communication in interviews with teenagers on sensitive topics

The research design with participation of children and adolescents has some distinctive features. They are caused by the legal status of this age group, its psycho-physiological characteristics, the place of the group itself and its autonomy in the system of social relations. Particular concern in collecting materials is caused by questions involving sensitivity. In conditions when the research participants themselves belong to the sensitized field, the difficulties are multiplied. The object of the 2019 study, conducted at the Sociology Clinic of Applied Research (St. Petersburg State University), was teenage girls 16-19 years old participating in the program “A Firm Step into Adulthood”. The informants had a sensitive experience such as raising without parents, staying in an orphanage. Therefore, such techniques as "peer-to-peer", projective techniques "Life Line", "Chamomile", and vignette questions were used to build effective communication. Interviews in the peer-to-peer format were not implemented to the fullest extent, as similarities in gender, age, and differences in social experiences between interviewers and informants did not allow to level the boundaries in interactions. The questions about Internet safety and drug risks were the most difficult to get truthful answers. Overall, the study showed that despite the blurring boundaries of social norms in older adolescence, the areas of life that are strictly controlled by social institutions proved to be the most sensitive for study participants compared to those considered as such in public opinion, such as the loss of parents.

Implicit Racial Bias in Pediatric Orthopaedic Surgery.

Racial and ethnic minority patients continue to experience disparities in health care. It is important to understand provider-level factors that may contribute to these inequities. This study aims to evaluate the presence of implicit racial bias among pediatric orthopaedic surgeons and determine the relationship between bias and clinical decision making. A web-based survey was distributed to 415 pediatric orthopaedic surgeons. One section measured for potential implicit racial bias using a child-race implicit association test (IAT). IAT scores were compared with US physicians and the US general population using publicly available data. Another section consisted of clinical vignettes with associated questions. For each vignette, surgeons were randomly assigned a single race-version, White or Black. Vignette questions were grouped into an opioid recommendation, management decision, or patient perception category for analysis based on subject tested. Vignette answers from surgeons with IAT scores that were concordant with their randomized vignette race-version (ie, surgeon with pro-White score assigned White vignette version) were compared with those that were discordant. IAT results were obtained from 119 surveyed surgeons (29% response rate). Overall, respondents showed a minor pro-White implicit bias ( P <0.001). Implicit bias of any strength toward either race was present among 103/119 (87%) surgeons. The proportion of pediatric orthopaedic surgeons with a strong pro-White implicit bias (29%) was greater than that of US physicians overall (21%, P =0.032) and the US general population (19%, P =0.004). No differences were found in overall opioid recommendations, management decisions, or patient perceptions between concordant and discordant groups. Most of the pediatric orthopaedic surgeons surveyed demonstrated implicit racial bias on IAT testing, with a large proportion demonstrating strong pro-White bias. Despite an association between implicit bias and clinical decision making in the literature, this study observed no evidence that implicit racial bias affected the management of pediatric fractures. Level IV.

Does the Formulation of the Decision Problem Affect Retirement?—Framing Effect and Planned Retirement Age

The aim of the study is to fill the research gap in relation to one of the behavioral factors that have a potential impact on retirement decisions—the framing effect. A research question addressed in the study is whether the way in which the decision-making problem is formulated (the framing effect) influences decisions on the planned retirement age. To answer this question, an original research questionnaire was developed. It included a description of a hypothetical pension system and experimental vignette questions. The research was conducted on the basis of answers given by 1079 randomly selected respondents who were participants of the pension system in Poland before retirement. In the analysis of the results, non-parametric tests and multiple logistic regression were used to compare response distributions. As a result of the conducted research, it was proven that the framing effect significantly affects the extension of the planned retirement age. At the same time, it was found that loss framing affects pension decisions to a greater extent than gain framing. It has also been noted that women are more susceptible than men to the framing of pension decisions. An application conclusion resulting from the conducted research is indicated as the possibility of the intentional use of the framing effect by decision-makers in order to increase the effective retirement age.

Recognition and reporting of child abuse by personnel of Flemish rural primary schools

This study, performed in 2019, examined which factors influenced recognition of child abuse and the need to intervene of school staff of primary schools in Flemish rural areas. One hundred and fifty staff members of primary schools filled out the Questionnaire Assessment of Situations of Child Abuse and answered for each vignette questions regarding recognition and perceived intervention need. Although school staff recognized most of the situations of child abuse, cases of emotional abuse were recognized less often. Compared to European victims, vignettes involving non-European victims were considered as more severe, and the need to involve professional help and to call in judicial authorities was greater. School personnel’s number of years of experience in education was positively associated with recognition, but negatively with the need to involve judicial authorities. The number of students in a school was associated with lower severity assessment and more children with low socio-economic status with a decreased likelihood of referral to a Confidential Center of Child Abuse and Neglect. Awareness of the fact that characteristics of the victim, staff characteristics and context characteristics influence detection and perceived intervention need of school personnel may result in more equal treatment for all victims.

Improving Learning Achievement on Family Medicine Topic by Increasing Learning Activity for Medical Students

Family medicine approach is the competence that must be mastered by the medical student. But in reality, family medicine is a topic that is less in demand by students. Students are more interested in basic and clinical medical science, or students do not yet understand the application of this approach in medical practice. Therefore, lecturers need to improve in learning methods such as increasing learning activity to enhance the learning achievement of family medicine topics. The purpose of this study is to find increasing learning achievement by increasing learning activity in this subject. Research method in this study is quantitative descriptive with a cross-sectional approach. We use pre-test and post-test scores of 40 medical students who attended the family medicine class. The instrument used is a quiz question that amounts to 5 items in the form of vignette questions with MCQ options. Researchers analyzed data with the Wilcoxon test. The results of this study showed there was a significant difference in pre-test compared with post-test with p<0.01 (p=0.000). This study concludes that increasing learning activities can effectively increase medical students' scores on family medicine topics. It is needed to further research on other learning methods that can improve the achievement of student's learning related to this topic.

“His inner-self must be good”: An ethnographic-vignette study of social interactions between children with autism spectrum disorder and typically developing peers

Children with autism spectrum disorder (ASD) can benefit from greater social integration through positive peer relationships. The study aimed to understand children’s views toward autism as well as experiences of interactions between children with ASD and typically developing (TD) peers. After ethnographic observations in a mainstream primary school educating diverse students, interviews were conducted with 10 students with ASD and ten of their TD peers using open-ended and vignette questions about three hypothetical scenarios set in varied contexts: a classroom, a birthday party, and a public setting. Narrative analysis focused on how the children constructed their experiences in response to these vignettes. Children with ASD frequently experienced isolation in peer interactions. While their TD peers favored interactions with those with ASD, believing that their behaviors of concern are extrinsic and their intentions must be good, their lack of understanding of ASD and of social skills that could be used to facilitate more positive interactions could result in unintended harm and exclusion. Early school-based intervention would assist in increasing the acceptance of neurodevelopmental differences and diversity.

PENGARUH BIMBINGAN UJI KOMPETENSI ONLINE TERHADAP HASIL TRY OUT LOKAL UJI KOMPETENSI MAHASISWA AKPER RS. DUSTIRA

Uji kompetensi bertujuan untuk mencapai standar kompetensi lulus yang memenuhi standar kerja sebagai tenaga kesehatan. Oleh karena itu kelulusan uji kompetensi menjadi hal yang sangat penting bagi tenaga kesehatan untuk dapat memperoleh pengakuan terhadap kompetensi yang dimilikinya. Berbagai metode telah diterapkan oleh Institusi pendidikan untuk mempersiapkan mahasiswanya menghadapi uji kompetensi. Tujuan penelitian ini adalah untuk mengetahui pengaruh bimbingan uji kompetensi online terhadap hasil try out lokal uji kompetensi mahasiswa Akper RS. Dustira. Desain penelitian menggunakan one group pre-post test design. Populasi pada penelitian ini ialah mahasiswa tingkat III Akper RS. Dustira. Sampel penelitian sebanyak 125 responden diambil dengan teknik Purposive Sampling. Data diperoleh melalui kegiatan try out lokal uji kompetensi dengan jumlah soal 180 pertanyaan vignette yang telah disusun oleh tim yang memiliki sertifikat item development dan item review dengan sistem online. Analisis data menggunakan uji paired t test dengan α=0,05. Hasil penelitian menunjukkan bahwa rerata nilai pre test sebelum diberikan intervensi adalah 46,9110 dengan 38,4% responden belum dapat memenuhi batas lulus. Rerata nilai post test setelah diberikan intervensi adalah 80,2845 dengan 100% responden dapat memenuhi batas lulus. Bimbingan online terbukti secara signifikan meningkatkan nilai mahasiswa saat try out lokal uji kompetensi (p=0,000). Bimbingan online dapat dijadikan alternatif metode program untuk mempersiapkan mahasiswa menghadapi uji kompetensi.

Using externally collected vignettes to account for reporting heterogeneity in survey self-assessment

The anchoring vignette approach has grown in popularity as a method to adjust for reporting heterogeneity in self-reported survey questions, removing bias due to systematic variation in reporting styles across study respondents. The use of anchoring vignettes, however, has been limited to surveys where both self-reports and vignette questions have been included. This diminishes their wider application. We illustrate, using an application to self-reported health in a large household survey, how externally collected vignettes can be used to adjust for reporting heterogeneity in datasets that have not included anchoring vignettes. Given that self-reported measures are an important facet of social, health and economic research, we anticipate the approach described will lead to new applications of the anchoring vignette methodology.

앵커링 비네트(anchoring vignettes) 방법을 적용한 우리나라의 PISA 수학 설문 결과 분석

The anchoring vignettes method as an alternative to the questionnaire using the Likert scale was newly applied to the student survey in the 2012 Programme for International Student Assessment (PISA). The three levels of vignettes (high, medium, and low levels) were included in the student survey related to ‘Teacher Support’ and ‘Classroom Management’ in mathematics, the main domain in the PISA 2012. Based on responses to the vignette questions, the PISA provided adjusted scaled scores for 12 student survey constructs. This study re-visited the responses of the vignettes as well as the relevant survey constructs, particularly focusing on the Korean students. The study findings can provide meaningful implications for understanding the response patterns for the Korean students on attitudes toward mathematics and developing survey tools using vignettes.

Finding the moral space: Rethinking morality, social class and worldviews

As social beings, we are compelled to take moral position toward one another but the nature of the relationship between morality and social structure remains a point of discussion. This article proposes a relational perspective on the debate, which involves reconceptualizing moral views as simultaneously status markers and attempts to achieve self-worth. In order to do so, the argument borrows from Bourdieu a depiction of the class structure as a multidimensional space and follows Douglas’s understanding of culture and worldviews. The argument is supported by an analysis of an experimental survey design, relying on vignette questions to gauge moral worldviews. The data are processed using Multiple Correspondence Analysis, revealing that (1) people exhibit a consistency in their moral position-taking and that (2) a strong homology exists between the moral space and the space of social classes

A unique flipped classroom approach shows promising results in physician assistant education

Aims: The flipped classroom (FC) model utilizes pre-class foundational learning with in-class higher-order application exercises. FC approaches have reported positive perceptions and mixed academic performance outcomes in medical education; however, little evidence exists on their impact in the 56-week didactic curriculum of Physician Assistant (PA) education.Methods: A 4-week FC curriculum was piloted in a PA behavioral medicine course (n = 34). Before class, students completed online video modules. During class, students completed a pre-class quiz and answered clinical case-based questions in a think-pair-share format.Results: Students rated in-class time higher than a lecture-based segment of the same course (p = 0.028). Assessment of achievement emotions demonstrated increased enjoyment (p = 0.028) and decreased boredom (p < 0.001) in the FC curriculum with no difference in anxiety. The FC curriculum produced a 57.2 min increase in pre-class preparation time with no change in post-class studying time. Compared to historical lecture-based controls (n = 35), students in the FC curriculum scored significantly higher on clinical vignette questions (p = 0.019) with equivalent performance on other question formats.Conclusions: This study offers the first positive outcomes of an FC approach in PA education and provides a framework for improving academic performance while scaling back in-class time.

Cultural Themes and Discourse in EMDR Therapy

This research study examined 56 eye movement desensitization and reprocessing (EMDR) clinician responses to a case vignette to explore the question of how a sample of EMDR clinicians integrated the role of culture in EMDR therapy. A combination of basic interpretive and discourse analysis qualitative research methods examined participant responses to an online survey posting the vignette and several open-ended response questions. Results found that EMDR clinicians generally view the EMDR standard procedures as being flexible enough to meet client needs independent of cultural considerations. However, when prompted, the respondents were able to provide concrete examples of culture's potential influence. Furthermore, some implicit patterns of English language use suggested that there may be areas where more intentional reflection of the intersection of culture and EMDR may be warranted. The study serves as a catalyst for future inquiry on cultural issues in EMDR and validation of qualitative analytic strategies for EMDR research. The participants' responses also allowed an evaluation of how they conceptualized EMDR therapy and how they discussed EMDR with their clients. Identified themes included reflections on universality, reflections on cultural influences on treatment, individual differences in cultural identity, clinician identity interacting with treatment, EMDR process, and implicit cultural aspects of treatment.

Evaluating Learning Strategies for Independent Lifelong Learning Approaches

Students in integrated basic science courses in which normal and abnormal human embryological development is taught were given the option of using different learning tools to achieve competency of the assigned developmental topics. The goal of this investigation was to use a student survey to assess the value of each learning tool for the student, and whether any of these learning tools were of value to them in developing potential life‐long learning approaches. The available learning tools for the students included: assigned textbook reading, Word document handout of material with directed learning objectives/questions, video presentation of significant material, in‐class powerpoint lecture, self‐assessment multiple‐choice quiz questions, and self‐assessment multiple‐choice vignette questions. All learning tools were available to the students. A brief student survey was developed to assess the value of each recommended learning tool using a value scale of 0–5, with 5 being the highest value. In addition, students were asked to describe briefly why they found a specific learning tool beneficial to their learning of the subject material. A second question asked if any of these learning tools helped them develop potential life‐long learning approaches, and if so, which of these learning tools was most beneficial. When assessing the value of each learning tool to the student's learning, the students valued the quiz and vignette questions highest because it directed their learning to the clinical relevance of the topic covered in the Word document handout and the lecture information given via the video recording or powerpoint presentation. The textbook was valued lowest, but it was assessed to be valuable as a resource for more detailed information. When assessing the various learning tools for developing lifelong learning approaches, the use of clinical quiz and vignette questions was valued twice that of handouts or lecture type presentations. Written comments indicated that the questions were valued highly because the clinical scenarios emphasize the need to understand basic developmental processes. Use of a textbook for life‐longing learning was rated very low; however, searching the internet for answers was given as an alternative. The survey strongly suggests that clinical cases focusing on the learning objectives for a topic greatly raise the desire to learn, and that the use of multiple‐choice quiz and vignette questions significantly strengthens learning of the important topics.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Identifying Hesitation and Discomfort with Diagnosing Sepsis: Survey of a Pediatric Tertiary Care Center.

Pediatric sepsis remains a significant cause of morbidity and mortality despite the development of strategies proven to improve diagnosis and treatment. Specifically, early recognition and urgent therapy initiation are consistently associated with improved outcomes. However, providers bring these principles inconsistently to the bedside. The objective of this study was to describe practitioner knowledge of, and attitudes toward, sepsis as a means of identifying potentially modifiable factors delaying life-saving treatment. We hypothesized there would be difficulties with sepsis recognition and self-reported discomfort with making the diagnosis among all provider groups in a pediatric tertiary care center. Emergency department and inpatient pediatric physicians, nurses, and respiratory therapists in a single, freestanding children's hospital received an electronic survey. Likert scales permitted anonymous self-reporting of comfort and diagnostic delays. Seven clinical vignettes assessed diagnostic knowledge. Independent sample t tests and Chi-square compared responses. Three hundred two staff participated (73% response rate), 41% of whom had at least 10 years of clinical experience. One in 5 was uncomfortable alerting coworkers to a patient with suspected sepsis or septic shock, and almost half were uncomfortable doing so in cases of compensated shock. Every role self-reported diagnostic delays, including faculty physicians. On average, physicians answered a greater percentage of vignette questions correctly (66%), compared with nurses (58%; P = 0.013) and respiratory therapists (52%; P = 0.005). Sepsis knowledge deficits, provider discomfort, and diagnostic delays are prevalent within a tertiary care children's hospital. Their presence and scale suggest areas for future research and targeted intervention.

Patient perspectives on how physicians communicate diagnostic uncertainty: An experimental vignette study.

We evaluated the effects of three different strategies for communicating diagnostic uncertainty on patient perceptions of physician competence and visit satisfaction. Experimental vignette-based study design involving pediatric cases presented to a convenience sample of parents living in a large US city. Three vignettes were developed, each describing one of three different ways physicians communicated diagnostic uncertainty to parents-(i) explicit expression of uncertainty ('not sure' about diagnosis), (ii) implicit expression of uncertainty using broad differential diagnoses and (iii) implicit expression of uncertainty using 'most likely' diagnoses. Participants were randomly assigned to one of the three vignettes and then answered a 37-item web-based questionnaire. Outcome variables included parent-perceived technical competence of physician, trust and confidence, visit satisfaction and adherence to physician instructions. Differences between the three groups were compared using analysis of variance, followed by individual post hoc analyses with Bonferroni correction. Seventy-one participants completed the vignette questions. Demographic characteristics and scores on activation (parent activation measure [PAM]) and intolerance to uncertainty were similar across the three groups. Explicit expression of uncertainty was associated with lower perceived technical competence, less trust and confidence, and lower patient adherence as compared to the two groups with implicit communication. These latter two groups had comparable outcomes. Parents may react less negatively in terms of perceived competence, physician confidence and trust, and intention to adhere when diagnostic uncertainty is communicated using implicit strategies, such as using broad differential diagnoses or most likely diagnoses. Evidence-based strategies to communicate diagnostic uncertainty to patients need further development.

Are Clinical Vignette Questions Harder than Traditional Questions in Gross Anatomy Course?

The increased integration of clinical scenarios throughout the first-year gross anatomy course is widely supported in the USA. This early introduction of clinically relevant material has created a need for new assessments of relevant knowledge that include questions based on clinical vignettes. However, little is known about how dental/medical students handle these clinical vignette questions (CVQ) in gross anatomy examinations. Thus, using meaningful ways to compare CVQ with traditional questions (TQ) could justify validation of the CVQ assessment format for this course. This study compared student performance on matched sets of CVQ and TQ test items before and after training on CVQ items in a summer 2014 and 2015 pre-matriculation program gross anatomy course. The subject matter for this course consisted of two blocks (back and upper limb; head and neck), accompanied by cadaveric dissection. Our data show that, in comparison with the TQ format, students fared poorly in the CVQ format (P < 0.05) under two conditions: (1) no advanced training on this format, or (2) unprepared for the test. However, an encouraging finding of our study suggests that training on CVQ items before testing may greatly improve student performance on this specific format for high-performing groups (grades ≥ 70). Training did not seem to exert any beneficial effect on low-performing groups (grades < 70) in this study. Thus, our current study recommends the early familiarization/training on CVQ items in the gross anatomy course and possibly other basic science courses.

Determinants of Knowledge and Attitudes Regarding Pain among Nurses in a University Hospital: A Cross-sectional Study

The aim of this cross-sectional study was to evaluate the primary determinants of knowledge and attitudes regarding pain among nurses in a hospital setting. All registered nurses employed at participating units at a university hospital were invited to participate. Information on work experience, education, and hospital unit was evaluated using a questionnaire. The Knowledge and Attitude Survey Regarding Pain instrument was used to assess knowledge on pain management. The difference in knowledge between nurses with different levels of education was assessed with analysis of variance. The discriminatory ability of each question was determined with item response theory, and the association between correct answers to individual items and the total score were calculated using linear regression. Participants were 235 nurses, 51% of the 459 invited. The overall pain knowledge score was 26.1 (standard deviation 5.3, range 8-38) out of a total of 40 possible. Those with an advanced degree in nursing scored on average 2.9 points higher than those who did not have an advance degree (95% confidence interval: 0.9-4.7). Responses to clinical vignette questions showed more difference between nurses with different levels of knowledge of pain management than the other questions. Participants with the correct response to the best discriminatory item had 5.35 (95% confidence interval 4.08-6.61) points higher total score than those with an incorrect answer. Higher education is associated with better knowledge on pain management. To assess pain knowledge, the ability to interpret and solve a clinical vignette leads to better results than answering direct questions.