Peter V. Scoles

Growth and Development of the Pediatric Cervical Spine Documented Radiographically

Background: The radiographic anatomy of the cervical spine in children is complex and can be difficult to interpret. The present study was undertaken to document radiographically the growth and development of the cervical spine in a prospective, longitudinal manner and to establish standard radiographic measurements on the basis of findings in patients who were followed serially from the age of three months until skeletal maturity. Methods: The radiographic resources of the Cleveland Study of Normal Growth and Development (Bolton-Brush Collection, Cleveland, Ohio) were reviewed. From this large database, we identified fifty boys and forty-six girls who had a sufficient number of radiographs of the cervical spine for inclusion in our study. With use of a computerized image analyzer, the growth and development of the atlantodens interval, the diameter of the spinal canal, the Torg ratio, the height and width of the second through fifth cervical vertebral bodies, the height of the dens, and the ossification of the first cervical vertebra were assessed on serial radiographs made from the age of three months until skeletal maturity. Results: Serial measurements of the atlantodens interval, the anteroposterior diameter of the cervical canal, the height and anteroposterior width of the cervical vertebral bodies, and the height of the dens, made in normal, healthy children from the age of three months to fifteen years, are presented in tabular and graphic forms. The median Torg ratio was 1.47 for both males and females primarily, and it reached values of 1.06 for males and 1.10 for females by maturity. The anterior arch of the first cervical vertebra had ossified in 33% of the children by the age of three months and in 81% of the children by the age of one year. Closure of the synchondroses was completed in all children by the age of three years. Conclusions: The measurements presented in the current study are important because they are the first, as far as we know, to document the radiographic parameters of the cervical spine in children who were followed longitudinally from before the age of three years through the course of growth and development until skeletal maturity.

Progress testing in clinical science education: results of a pilot project between the National Board of Medical Examiners and a US Medical School.

Background: Though progress tests have been used for several decades in various medical education settings, a few studies have offered analytic frameworks that could be used by practitioners to model growth of knowledge as a function of curricular and other variables of interest. Aim: To explore the use of one form of progress testing in clinical education by modeling growth of knowledge in various disciplines as well as by assessing the impact of recent training (core rotation order) on performance using hierarchical linear modeling (HLM) and analysis of variance (ANOVA) frameworks. Methods: This study included performances across four test administrations occurring between July 2006 and July 2007 for 130 students from a US medical school who graduated in 2008. Measures-nested-in-examinees HLM growth curve analyses were run to estimate clinical science knowledge growth over time and repeated measures ANOVAs were run to assess the effect of recent training on performance. Results: Core rotation order was related to growth rates for total and pediatrics scores only. Additionally, scores were higher in a given discipline if training had occurred immediately prior to the test administration. Conclusions: This study provides a useful progress testing framework for assessing medical students’ growth of knowledge across their clinical science education and the related impact of training.

Gathering Evidence of External Validity for the Foundations of Medicine Examination: A Collaboration Between the National Board of Medical Examiners and the University of Minho

Background To gather evidence of external validity for the Foundations of Medicine (FOM) examination by assessing the relationship between its subscores and local grades for a sample of Portuguese medical students. Method Correlations were computed between six FOM subscores and nine Minho University grades for a sample of 90 medical students. A canonical correlation analysis was run between FOM and Minho measures. Results Moderate correlations were noted between FOM subscores and Minho grades, ranging from −0.02 to 0.53. One canonical correlation was statistically significant. The FOM variate accounted for 44% of variance in FOM subscores and 22% of variance in Minho end-of-year grades. The Minho canonical variate accounted for 34% of variance in Minho grades and 17% of the FOM subscore variances. Conclusions The FOM examination seems to supplement local assessments by targeting constructs not currently measured. Therefore, it may contribute to a more comprehensive assessment of basic and clinical sciences knowledge.

Collecting evidence of content validity for the international foundations of medicine examination: an expert-based judgmental approach.

INTRODUCTION The term global village is commonly used to express how human actions are inextricably linked across geographic barriers. This phenomenon is also manifest in medical education via a number of initiatives, including telemedicine,1 distance learning technologies,2 and the establishment of satellite campuses.3 Furthermore, movement of medical practitioners and students across borders is now commonplace for a host of reasons, among them training opportunities4 as well as labor demands and opportunities.5 The latter situations are especially relevant in Europe, due to government-initiated programs, such as the Bologna Process, that promote movement and exchanges of medical professionals across borders.6 This greater degree of mobility has highlighted the need to develop common educational standards to guide quality improvement efforts and to serve as an accreditation framework for medical schools around the world. The World Federation of Medical Education has proposed guidelines that are useful in this respect in that they allow medical schools to self-evaluate against a number of guidelines both for program improvement purposes and to better prepare for external program reviews.7 The Institute for International Medical Education also elaborated its Global Minimum Essential Requirements to aid both students and medical schools seeking to meet international standards of competence in a number of domains, as determined by a worldwide panel of faculty.8

Assessing the reliability and validity of a residency selection process examination: a preliminary study between the national board of medical examiners and the University of Panama Faculty of Medicine.

Background: The Ministry of Health of the Republic of Panama is currently developing a national examination system that will be used to license graduates to practice medicine in that country, as well as to undertake postgraduate medical training. As part of these efforts, a preliminary project was undertaken between the National Board of Medical Examiners (NBME) and the Faculty of Medicine of the University of Panama to develop a Residency Selection Process Examination (RSPE). Purpose: The purpose of this study was to assess the reliability and validity of RSPE scores for a sample of candidates who wished to obtain a residency slot in Panama. Methods: The RSPE, composed of 200 basic and clinical sciences multiple-choice items, was administered to 261 residency applicants at the University of Panama. Results: The reliability estimate computed was comparable with that reported with other high-stakes examinations (Cronbachs α = 0.89). Also, a Rasch examinee proficiency item difficulty plot showed that the RSPE was well targeted to the proficiency levels of candidates. Finally, a moderate correlation was noted between local grade point averages and RSPE scores for University of Panama students (r = 0.38). Conclusions: Findings suggest that it is possible to translate and adapt test materials for use in other contexts.