Peta-Ann Teague

Improving assessment practice through cross-institutional collaboration: An exercise on the use of OSCEs

Abstract Background: This study was undertaken to improve assessment practice on OSCEs through collaboration across geographically dispersed medical schools in Australia. Methods: A total of eleven OSCE stations were co-developed by four medical schools and used in summative 2011 and 2012 examinations for the assessment of clinical performance in the early clinical and exit OSCEs in each school’s medical course. Partial Credit Rasch Model was used to evaluate the psychometric properties of the shared OSCE data. Evaluation of the quality assurance reports was used to determine the beneficial impact of the collaborative benchmarking exercise on learning and teaching outcomes. Results: The data for each examination demonstrated sufficient fit to the Rasch model with infit mean square values ranging from 0.88 to 0.99. Person separation (1.25–1.63) indices indicated good reliability. Evaluation of perceived benefits showed that the benchmarking process was successful as it highlighted common curriculum areas requiring specific focus and provided comparable data on the quality of teaching at the participating medical schools. Conclusion: This research demonstrates the validity of the psychometric data and benefits of evaluating clinical competence across medical schools without the enforcement of a prescriptive national curriculum or assessment.

A collaborative comparison of Objective Structured Clinical Examination (OSCE) standard setting methods at Australian medical schools

Abstract Background: A key issue underpinning the usefulness of the OSCE assessment to medical education is standard setting, but the majority of standard-setting methods remain challenging for performance assessment because they produce varying passing marks. Several studies have compared standard-setting methods; however, most of these studies are limited by their experimental scope, or use data on examinee performance at a single OSCE station or from a single medical school. This collaborative study between 10 Australian medical schools investigated the effect of standard-setting methods on OSCE cut scores and failure rates. Methods: This research used 5256 examinee scores from seven shared OSCE stations to calculate cut scores and failure rates using two different compromise standard-setting methods, namely the Borderline Regression and Cohen’s methods. Results: The results of this study indicate that Cohen’s method yields similar outcomes to the Borderline Regression method, particularly for large examinee cohort sizes. However, with lower examinee numbers on a station, the Borderline Regression method resulted in higher cut scores and larger difference margins in the failure rates. Conclusion: Cohen’s method yields similar outcomes as the Borderline Regression method and its application for benchmarking purposes and in resource-limited settings is justifiable, particularly with large examinee numbers.

Risk factors associated with academic difficulty in an Australian regionally located medical school

BackgroundDespite the highly selective admission processes utilised by medical schools, a significant cohort of medical students still face academic difficulties and are at a higher risk of delayed graduation or outright dismissal.MethodsThis study used survival analysis to identify the non-academic and academic risk factors (and their relative risks) associated with academic difficulty at a regionally located medical school. Retrospective non-academic and academic entry data for all medical students who were enrolled at the time of the study (2009–2014) were collated and analysed. Non-academic variables included age at commencement of studies, gender, Indigenous status, origin, first in family to go to University (FIF), non-English speaking background (NESB), socio-economic status (SES) and rurality expressed as Australian Standard Geographical Classification-Remoteness Area (ASGC-RA). Academic variables included tertiary entrance exam score expressed as overall position (OP) and interview score. In addition, post-entry mid- and end-of-year summative assessment data in the first and second years of study were collated.ResultsThe results of the survival analysis indicated that FIF, Indigenous and very remote backgrounds, as well as low post-entry Year 1 (final) and Year 2 (mid-year and final) examination scores were strong risk factors associated with academic difficulty. A high proportion of the FIF students who experienced academic difficulty eventually failed and exited the medical program. Further exploratory research will be required to identify the specific needs of this group of students in order to develop appropriate and targeted academic support programs for them.ConclusionsThis study has highlighted the need for medical schools to be proactive in establishing support interventions/strategies earlier rather than later, for students experiencing academic difficulty because, the earlier such students can be flagged, the more likely they are able to obtain positive academic outcomes.

A systematic review of smoker and non-smoker perceptionsof visually unappealing cigarette sticks

INTRODUCTION Cigarette stick appearance can significantly contribute to perceptions of cigarette taste, harm, and appeal, and may be modified to reduce positive perceptions of cigarettes and other tobacco products. A systematic review was conducted to investigate how smokers and non-smokers identify cigarettes as being attractive or unattractive, and the resulting perceptions of cigarette appeal, perceived harm, and impact on quit intentions. METHODS Eligible articles were identified using database searches conducted with a date range of January 1990 to May 2017 in PubMed, CINAHL, PsycINFO, Google Scholar and Web of Science. Articles were included if they evaluated participant (any smoking status) perceptions of visual cigarette stick attributes. We identified studies describing visual attributes of cigarette sticks and the resulting perceptions of participants. Changes or differences in quitting intentions, cigarette appeal, perceptions of taste, and cigarette harm, and the likelihood of smoking uptake were recorded. Data were grouped into two main categories: those of physical cigarette design, and those including health messages on cigarette sticks. RESULTS Of the 950 identified non-duplicated records, 9 matched the eligibility criteria. These studies were all conducted in developed countries, and largely enrolled adolescent and young adult smokers and non-smokers. Slim, lighter coloured and branded cigarettes were favoured over longer, broader, or darker coloured cigarettes, and those without any branding or embellishments. Health warnings including ‘Minutes of life lost’, ‘Smoking kills’, and the names of carcinogenic constituents in cigarettes, reduced cigarette attractiveness and increased participant quit intentions. CONCLUSIONS Cigarette appeal and resulting smoking behaviours can be influenced by several visual attributes of individual cigarettes. Unappealing visual attributes of cigarette sticks, including modifications to the size and colour of cigarettes, and the inclusion of health warnings on cigarette sticks may serve as an effective tobacco control method, potentially leading to a reduction in tobacco use.

Addressing varenicline adherence through repackaging in a dose administration aid

Background Ensuring adherence to prescribed smoking cessation medications, such as Champix® (varenicline), is essential during a quit attempt as non-adherence can significantly reduce the likelihood of achieving prolonged smoking abstinence. The use of dose administration aids may improve adherence, though medication stability on repackaging is not guaranteed, due to a lack of available data from manufacturers supporting this practice. Objective To determine the suitability for repackaging varenicline tartrate tablets into a dose administration aid, by assessing its physical and chemical stability after being repackaged and stored at ambient conditions for 6 weeks. Methods Varenicline tartrate (1.0 mg) tablets were repackaged into commercially available Webster-pak® blister compartments and stored for 42 days at ambient conditions characteristic of a Zone IVB climate (30 ± 2°C and 75 ± 5% relative humidity) according to the World Health Organization (WHO) guidelines on pharmaceutical stability testing. Physical and chemical tests were performed on the repackaged and control tablets, including an assessment of: tablet thickness, hardness, weight uniformity, friability, dissolution, disintegration, and content uniformity after exposure to ambient conditions and light according to International Council on Harmonisation of Technical Requirements of Pharmaceuticals for Human Use guideline Q1B. Results Weight, friability, and thickness of the tablets complied with compendial standards. A validated high performance liquid chromatography method was used to confirm that after exposure to light, and repackaging at 30°C/75% relative humidity, the tablets remained within the required 95%–105% of the stated drug content. However, tablet hardness and disintegration decreased over time, with tablets becoming softer and undergoing more rapid disintegration in water. Conclusion Repackaging 1.0 mg varenicline tartrate tablets into a dose administration aid can be undertaken to improve adherence rates and therefore smoking abstinence rates. This can be performed without compromising either the physical or chemical stability of the tablets.

Australian community pharmacist experiences with smoking cessation and opinions of health warnings on individual cigarette sticks

We aimed to identify the experiences of Australian community pharmacists with smokers and their associated perceptions of effective health warnings on individual cigarette sticks.

Australian School Student Perceptions of Effective Anti-Tobacco Health Warnings

Background: Recent research posits that anti-tobacco health warnings on cigarette packaging may gradually lose their effectiveness in dissuading adolescents from tobacco products several years after implementation. Health warnings on individual cigarette sticks represent a novel warning medium, and may further educate adolescents on the dangers associated with smoking, and reduce tobacco experimentation amongst this vulnerable population. Methods: In an online survey of school students in Queensland, Australia, participants were requested to rate (on five-point Likert scales) and comment on the perceived effectiveness of current cigarette packaging warnings, and 12 text warnings on cigarette sticks, in preventing non-smokers from smoking, and encouraging current smokers to quit. The warnings were divided into four themes to establish the most effective types of anti-tobacco messages: mortality statistics, health condition consequences, social and financial consequences, and supportive messages. These themes were based on current anti-tobacco interventions within Australia, and the rising cost of tobacco products, and designed to align with the Health Belief Model. Results: Participants (N = 150; Age = 15–18) from five schools completed the survey, and generally viewed current packaging warnings as gross and disgusting, and rating them as somewhat effective in preventing non-smokers from smoking. Current warnings were however considered less effective in prompting current smokers to quit with participants describing them as being un-relatable to teenagers, and smokers as having become desensitized to the warnings used. One theme of cigarette-stick warning (mortality statistics) was rated as significantly more effective (p < 0.001) than current cigarette packaging, with an odds ratio (OR) of 2.77 (95% confidence interval [CI]: 1.67–4.62). Overall, warnings were considered to be 4.71 times (95%CI: 2.72–6.43, p < 0.001) more effective on non-smokers than on smokers. Over three-quarters of participants supported using health warnings on individual cigarette sticks. Conclusions: Current cigarette packaging warnings have retained some effectiveness in dissuading adolescents from smoking, though novel and thought-provoking text-only warnings on cigarette sticks may serve as an additional intervention in reducing tobacco use. Further research requires identification of the most effective warnings, and the perceptions of a more diverse participant base.

Correction to: Risk factors associated with academic difficulty in an Australian regionally located medical school

Following publication of the original article [1], one of the authors reported that prior to publication her surname had changed from ‘Kerlen’ to ‘van der Kruk’, but that this change had not been incorporated in the final version.