Rukhsana Wamiq Zuberi

Case studies in outcome-based education

Outcome-based education is one of the most significant global developments in medical education in recent years. This paper presents four case studies of outcome-based education from medical schools in different parts of the world; Scotland; USA; Pakistan; and Singapore. The outcome-based curricula have either been in place for some time, are evolving or are at the planning proposal stage. The outcomes, change process and implementation of the outcome-based approach are described. Variation in the extent to which each medical school has implemented outcome-based education is discussed and key points for successful implementation are highlighted. This paper is based on the pre-conference symposium “outcome-based curricula: global perspectives” presented by the authors at the 4th Asia Pacific Medical Education Conference (APMEC) in Singapore, 8–11 February, 2007.

Association of Sociodemographic Factors With Depression in Women of Reproductive Age

Introduction. Women suffer disproportionately from depression, which has a high prevalence in developing countries. Sociodemographic factors are associated with depression, some of which may be modifiable and lead to better outcomes for depression among women. Objectives. To determine sociodemographic factors associated with depression among women of reproductive age in Karachi. Methods. A case control study was conducted on 376 women in 2 hospitals in Karachi. Patients were diagnosed by psychiatrists and family physicians by Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria and SRQ20. Results. The odds for women with depression being married for >5 years, being abused by in-laws, spending ≤3 hours per day with their spouses, and being just satisfied or not satisfied with their married life was more than that for controls. Conclusion. The authors’ findings highlight the important modifiable risk factors for depression, which if addressed will help decrease the burden of depression among women.

Standard Setting Methods for Pass/Fail Decisions on High-Stakes Objective Structured Clinical Examinations: A Validity Study

Construct: Authentic standard setting methods will demonstrate high convergent validity evidence of their outcomes, that is, cutoff scores and pass/fail decisions, with most other methods when compared with each other. Background: The objective structured clinical examination (OSCE) was established for valid, reliable, and objective assessment of clinical skills in health professions education. Various standard setting methods have been proposed to identify objective, reliable, and valid cutoff scores on OSCEs. These methods may identify different cutoff scores for the same examinations. Identification of valid and reliable cutoff scores for OSCEs remains an important issue and a challenge. Approach: Thirty OSCE stations administered at least twice in the years 2010–2012 to 393 medical students in Years 2 and 3 at Aga Khan University are included. Psychometric properties of the scores are determined. Cutoff scores and pass/fail decisions of Wijnen, Cohen, Mean–1.5SD, Mean–1SD, Angoff, borderline group and borderline regression (BL-R) methods are compared with each other and with three variants of cluster analysis using repeated measures analysis of variance and Cohens kappa. Results: The mean psychometric indices on the 30 OSCE stations are reliability coefficient = 0.76 (SD = 0.12); standard error of measurement = 5.66 (SD = 1.38); coefficient of determination = 0.47 (SD = 0.19), and intergrade discrimination = 7.19 (SD = 1.89). BL-R and Wijnen methods show the highest convergent validity evidence among other methods on the defined criteria. Angoff and Mean–1.5SD demonstrated least convergent validity evidence. The three cluster variants showed substantial convergent validity with borderline methods. Conclusions: Although there was a high level of convergent validity of Wijnen method, it lacks the theoretical strength to be used for competency-based assessments. The BL-R method is found to show the highest convergent validity evidences for OSCEs with other standard setting methods used in the present study. We also found that cluster analysis using mean method can be used for quality assurance of borderline methods. These findings should be further confirmed by studies in other settings.

Problem-based learning: Where are we now? Guide supplement 36.2 - Viewpoint

The educational principles of self-directed, collaborative, and life-long learning can be effectively inculcated into the curriculum where PBL is adopted as a major learning strategy instead of PBL as a whole-curriculum-concept. In developing countries, where the entry level of the majority of students is at the high-school leaving level, a guided discovery model may well be the answer. A curriculum that introduces students to carefully constructed problems sequenced according to a matrix design ranging from simple to complex conditions and according to a logical progression of anatomical and/or physiological and/or pathological and/or pharmacological concepts makes learning easier. Centralized curricular governance, conceptualization and management have a very strong impact on the kind of curriculum, or more specifically which variant of PBL, an institution is able to implement. However, decentralized empowerment of a large number of faculty members is crucial for faculty ownership. A curricular change, especially to PBL from a traditional curriculum, demands adequate preparation time of at least 2–3 years. The time between proposing the change to introducing the change should focus not only on faculty development and training, development of the curriculum and its policies, but also on resource development and preparation of the student body.