Hossam Hamdy

BEME systematic review: Predictive values of measurements obtained in medical schools and future performance in medical practice

Background: Effectiveness of medical education programs is most meaningfully measured as performance of its graduates. Objectives: To assess the value of measurements obtained in medical schools in predicting future performance in medical practice. Methods: Search strategy: The English literature from 1955 to 2004 was searched using MEDLINE, Embase, Cochranes EPOC (Effective Practice and Organization of Care Group), Controlled Trial databases, ERIC, British Education Index, Psych Info, Timelit, Web of Science and hand searching of medical education journals. Inclusion & exclusions: Selected studies included students assessed or followed up to internship, residency and/or practice after postgraduate training. Assessment systems and instruments studied (Predictors) were the National Board Medical Examinations (NBME) I and II, preclinical and clerkship grade-point average, Observed Standardized Clinical Examination scores and Undergraduate Deans rankings and honors society. Outcome measures were residency supervisor ratings, NBME III, residency in-training examinations, American Specialty Board examination scores, and on-the-job practice performance. Data extraction: Data were extracted by using a modification of the BEME data extraction form study objectives, design, sample variables, statistical analysis and results. All included studies are summarized in a tabular form. Data analysis and synthesis: Quantitative meta-analysis and qualitative approaches were used for data analysis and synthesis including the methodological quality of the studies included. Results: Of 569 studies retrieved with our search strategy, 175 full text studies were reviewed. A total of 38 studies met our inclusion criteria and 19 had sufficient data to be included in a meta-analysis of correlation coefficients. The highest correlation between predictor and outcome was NBME Part II and NBME Part III, r = 0.72, 95% CI 0.30–0.49 and the lowest between NBME I and supervisor rating during residency, r = 0.22, 95% CI 0.13–0.30. The approach to studying the predictive value of assessment tools varied widely between studies and no consistent approach could be identified. Overall, undergraduate grades and rankings were moderately correlated with internship and residency performance. Performance on similar instruments was more closely correlated. Studies assessing practice performance beyond postgraduate training programs were few. Conclusions: There is a need for a more consistent and systematic approach to studies of the effectiveness of undergraduate assessment systems and tools and their predictive value. Although existing tools do appear to have low to moderate correlation with postgraduate training performance, little is known about their relationship to longer-term practice patterns and outcomes.

Adult learning theories: Implications for learning and teaching in medical education: AMEE Guide No. 83

There are many theories that explain how adults learn and each has its own merits. This Guide explains and explores the more commonly used ones and how they can be used to enhance student and faculty learning. The Guide presents a model that combines many of the theories into a flow diagram which can be followed by anyone planning learning. The schema can be used at curriculum planning level, or at the level of individual learning. At each stage of the model, the Guide identifies the responsibilities of both learner and educator. The role of the institution is to ensure that the time and resources are available to allow effective learning to happen. The Guide is designed for those new to education, in the hope that it can unravel the difficulties in understanding and applying the common learning theories, whilst also creating opportunities for debate as to the best way they should be used.

Student-led tutorials in problem-based learning: educational outcomes and students' perceptions

The aim of this study was to examine the effectiveness of using students as tutors in a problem-based learning (PBL) medical curriculum. Ninety-one third-year medical students were divided into ten tutorial groups. The groups were randomly allocated into student-led tutorials (SLT) (five groups, n = 44 students) and faculty-led tutorials (FLT) (five groups, n = 47 students). Outcome measurements included assessment of students’ performance in tutorials individually and as a group, end-unit examinations scores, assessment of tutoring skills and identifying students’ perceptions about peer tutoring. Student tutors were perceived better in providing feedback and in understanding the difficulties students face in tutorials.Tutorial atmosphere, decision-making and support for the group leader were better in SLT compared with FLT groups. Self-assessment of student performance in SLT was not different from FLT. Student scores in the written and practical examinations were comparable in both groups. However, SLT groups found difficulties in analysis of problems presented in the first tutorial session. We conclude that the impact of peer tutoring on student performance in tutorials, group dynamics, and student achievement in examinations is positive overall. However, student tutors require special training before adopting this approach in PBL programs.

Reliability and validity of the direct observation clinical encounter examination (DOCEE)

Context  The College of Medicine and Medical Sciences at the Arabian Gulf University, Bahrain, replaced the traditional long case/short case clinical examination on the final MD examination with a direct observation clinical encounter examination (DOCEE). Each student encountered four real patients. Two pairs of examiners from different disciplines observed the students taking history and conducting physical examinations and jointly assessed their clinical competence.

Blueprinting for the assessment of health care professionals

A n important approach that has evolved and been emphasised in the assessment of health professionals is the blueprint approach to assessment construction. Like ‘portfolio’, a term that has been borrowed by medical education from the arts, ‘blueprint’ has been borrowed from architecture. It indicates that a process of assessment needs to be conducted according to a replicable plan. This fundamental procedure, as a precursor to test construction and item choice, ensures that test content is mapped carefully against learning objectives to produce a ‘valid examination’. It generates congruence between the subject matter delivered during instruction, or competencies expected to be acquired by the student, and the items that appear in the test.

Gender-Related Differences in Learning in Student-Led PBL Tutorials

CONTEXT Male and female students behave differently in problem-based learning (PBL) tutorials. However, these differences could be partly attributed to faculty tutor behavior in male and female tutorials. OBJECTIVES This study aims to examine the gender differences in learning outcomes between medical students when peer tutors facilitate PBL tutorials. METHODS A questionnaire-based study conducted in single-gender student-led (SLT) and faculty-led (FLT) tutorials. The study involved third year medical students (n = 91) divided into ten groups (five groups each). The SLT groups consisted of 16 male and 28 female students, while the FLT group consisted of 20 male and 27 female students. Students evaluated their individual and group performance in tutorials and also skills of tutors. Student performance in end-unit examinations and their perceptions about peer tutoring were also analyzed. RESULTS A total of 290 questionnaires (response rate = 63.7%) were collected over the five-week period of the study. Although individual performance in tutorials and achievement in examinations were comparable in both groups, there was significantly higher group performance in female compared with male student-led tutorials (p < 0.01). This difference between male and female groups was not attributed to improvement in the performance of female groups, but rather to a decline in performance of the male SLT groups. In addition, both male and female students expressed facing difficulties in discussion and analysis of the problem in the first tutorial session. CONCLUSIONS Understanding the gender differences in the group behavior in student-led tutorials is important for PBL programs adopting this approach.

Integrating applied anatomy in surgical clerkship in a problem-based learning curriculum

Little attention has been given to structured teaching of applied anatomy to senior medical students in problem-based learning (PBL) medical schools. A course named “Anatomical Principles in Surgical Practice” was introduced at the Arabian Gulf University (AGU) in 2001 for fifth- and sixth-year medical students during their surgical clerkship rotation. The course aims to emphasize, update and integrate applied anatomical concepts that are essential for surgical practice. The course consists of 15 interactive sessions held weekly to ensure topics coincide with the surgical problem-solving sessions. A questionnaire was administered to students completing their surgical rotations (n=131) seeking their perceptions about the new course during the academic years 2001, 2002 and 2003. To measure learning outcome, 70 students were also given pre- and post-tests. Positive responses were given by 85.2% of the students for course arrangement, by 92.0% for course content, by 88.3% for clinical correlation, by 95.2% for level of teaching and by 87.2% for overall judgment. The students’ mean scores in the post-test (71.7%±11.7) was significantly higher than their mean scores in the pre-test (42.3%±12.6, p<0.001). Students liked the course and reported feeling more confident in correlating anatomy with surgery during their rotations. By extending anatomical teaching into the clerkship phase, a link between basic medical and clinical sciences has been established that further enhances vertical integration within a PBL curriculum in a spiral fashion.

The Arabian Gulf University College of Medicine and Medical Sciences: a successful model of a multinational medical school.

In the late 1970s, leaders of the Arabian [corrected] Gulf countries proposed a novel idea of a joint educational and cultural venture: establishing a new regional university based in the Kingdom of Bahrain that would be managed as a multinational consortium of Gulf countries including Saudi Arabia, United Arab Emirates, Kuwait, Oman, Qatar, and Bahrain. It was intended to promote higher education and research in the Gulf region; to serve the development needs of the region; to reflect the unique economic, social, and cultural attributes of the Gulf communities and their environments; and to respond to the health care needs of the member countries. Since its inception in 1982, the College of Medicine and Medical Sciences (CMMS) at Arabian Gulf University (AGU) has adopted the educational philosophy of problem-based learning (PBL) and self-directed, student-centered education. The curriculum is integrated, with early introduction of education to foster clinical skills and professional competencies. The strategic alliance with the health care systems in Bahrain and other Gulf regions has created a successful model of efficient and effective initialization of health care resources in the community. The experience that has accumulated at the AGU-CMMS from introducing innovative medical education has allowed it to take a leadership position in medical education in the Gulf region. The original goals of this unique experiment have been realized along with unanticipated outcomes of spearheading changes in medical education in the Gulf region. Old and new medical schools have adopted several characteristics of the AGU educational program. Several elements contributed to its success: a clear vision of providing quality medical education and realizing and sustaining this vision by a supportive leadership at the university and college levels; an alliance with the regional health care systems; a dedicated faculty who have been able to work as a team while continually developing themselves; proper student selection and the creation of a culture of student/faculty partnerships in education and in building an international reputation and credibility by cooperating with reputable international universities and organizations.

Effects of endothelin‐A receptor antagonism on bilateral renal function in renovascular hypertensive rats

Recent studies indicated an enhanced expression of Endothelin (ET) in the kidney contralateral to the vascular clip in two‐kidney, one‐clip (2K‐1C) Goldblatt hypertension. We proposed that the enhanced intrarenal ET production might be responsible for altered haemodynamic and excretory capability of the unclipped kidney (UK) of 2K‐1C renovascular hypertensive rats. Therefore, we examined the changes in arterial pressure and split renal function in the clipped (CK) and UK simultaneously, in response to chronic administration of the selective ETA receptor blocker (A‐127722), given orally at a dose of 30 mg/kg/day for 3 weeks starting from the beginning of the 4th week of clipping. Systolic pressure averaged 177 ± 7 mmHg in control rats (n=15) and 164 ± 9 mmHg in treated rats (n=16) and the difference was not statistically different. Glomerular filtration rate (GFR), renal plasma flow (RPF) and renal vascular resistance (RVR) in the UK were not different between control and treated groups. Data were then analyzed by classifying rats as moderate hypertensives (MAP < 180 mmHg), and severe hypertensives (MAP > 180 mmHg). In the moderately hypertensive group, average MAP was 143 ± 5 mmHg and 138 ± 4 mmHg in control (n=9) and treated (n=10) groups, respectively. In the severely hypertensive group, average MAP was 192 ± 5 mmHg and 188 ± 5 mmHg in control (n=6) and treated (n=6) groups, respectively. GFR and RPF were significantly improved in the UK of only the severely hypertensives who received the antagonist. However, the ETA antagonist blunted the sodium loss in both CK and UK of severely hypertensive rats. We conclude that ETA receptors do not play a role in the progression of hypertension in 2K‐1C renovascular hypertensive rats. Yet, ETA receptors play an important role in altering renal hemodynamics of the unclipped kidneys in severe degrees of renovascular hypertension.

Clinical anatomy in the clerkship phase of a problem-based medical curriculum.

Context and setting The Arabian Gulf University (AGU) College of Medicine has adopted a problembased, integrated organ-system medical curriculum. The 6-year curriculum is organised in 3 phases: premedical (1 year), preclerkship (3 years), and clerkship (2 years). The bulk of anatomy material is taught in the middle phase as an integrated part of problem-based, organ-system units involving basic medical as well as clinical sciences. However, there was no input of anatomy teaching in the third clinical phase, which basically involved hospital-based rotations. Therefore, students in this final phase were at a disadvantage in terms of applying and correlating anatomical concepts in clinical practice, particularly in surgery. Why the idea was necessary We envisaged that by ensuring continuity of anatomical teaching throughout the clinical phase, a link between basic medical sciences and clinical sciences would be established and would increase vertical integration. In addition, we perceived a need to tie up loose ends and fill in the gaps that may have been overlooked during the study of health cases of various system units in the preclerkship phase. What was done A new course named ‘Anatomical Principles in Surgical Practice’ was designed and implemented at the beginning of the academic year 2001–02. It was taken by medical students in Years 5 and 6 during their surgical clerkship rotation (each rotation runs for 16 weeks and involves an average of 20 students). The course consisted of 15 interactive tutorial ⁄ seminar sessions; each session was held weekly and lasted for 90 minutes. The aim of this course was to emphasise, refocus and vertically integrate applied anatomical concepts and facts that are essential for surgical practice. The course content was planned in consultation and co-ordination with surgeons involved in the training of students in order to ensure that each weekly topic coincided with the weekly surgical problem or theme in question. Thus the course topics were selected on the basis of 5 main themes or categories which involved the anatomical principles of: surgical techniques ⁄operations (e.g. hernial repair, abdominal incisions); signs and symptoms of common surgical diseases (e.g. referred pain such as renal or biliary colic, breast cancer); pathophysiology of certain surgical diseases (e.g. porto-systemic shunt, intestinal obstruction); normal development and associated common congenital abnormalities (e.g. midgut rotation), and orthopaedic trauma (e.g. fractures and dislocations, neurovascular injuries). The majority of the sessions were taught by 2 experienced clinical anatomists (first 2 authors), with some contribution from 2 senior surgeons. Evaluation of results and impact A qualitative study, using a questionnaire and focus group discussions, was carried out at the end of each rotation. A total of 6 rotations were completed for the academic years 2001–02 and 2002–03. The questionnaire was structured in such a way as to sample students’ opinions of the course, using a Likert scale of 1–5, with regard to level of organisation, suitability of selected topics and information level for their surgical training, level of teaching, support for continuing such a course, and overall rating of the course. To measure the impact of the course on students’ performance, a quantitative study was conducted using 2 parameters: