Takuya Saiki

Past-behavioural versus situational questions in a postgraduate admissions multiple mini-interview: a reliability and acceptability comparison

BackgroundThe Multiple Mini-Interview (MMI) mostly uses ‘Situational’ Questions (SQs) as an interview format within a station, rather than ‘Past-Behavioural’ Questions (PBQs), which are most frequently adopted in traditional single-station personal interviews (SSPIs) for non-medical and medical selection. This study investigated reliability and acceptability of the postgraduate admissions MMI with PBQ and SQ interview formats within MMI stations.MethodsTwenty-six Japanese medical graduates, first completed the two-year national obligatory initial postgraduate clinical training programme and then applied to three specialty training programmes - internal medicine, general surgery, and emergency medicine - in a Japanese teaching hospital, where they underwent the Accreditation Council for Graduate Medical Education (ACGME)-competency-based MMI. This MMI contained five stations, with two examiners per station. In each station, a PBQ, and then an SQ were asked consecutively. PBQ and SQ interview formats were not separated into two different stations, or the order of questioning of PBQs and SQs in individual stations was not changed due to lack of space and experienced examiners. Reliability was analysed for the scores of these two MMI question types. Candidates and examiners were surveyed on this experience.ResultsThe PBQ and SQ formats had generalisability coefficients of 0.822 and 0.821, respectively. With one examiner per station, seven stations could produce a reliability of more than 0.80 in both PBQ and SQ formats. More than 60% of both candidates and examiners felt positive about the overall candidates’ ability. All participants liked the fairness of this MMI when compared with the previously experienced SSPI. SQs were perceived more favourable by candidates; in contrast, PBQs were perceived more relevant by examiners.ConclusionsBoth PBQs and SQs are equally reliable and acceptable as station interview formats in the postgraduate admissions MMI. However, the use of the two formats within the same station, and with a fixed order, is not the best to maximise its utility as an admission test. Future studies are required to evaluate how best the SQs and PBQs should be combined as station interview formats to enhance reliability, feasibility, acceptability and predictive validity of the MMI.

The overall impact of testing on medical student learning: quantitative estimation of consequential validity

Given medical education’s longstanding emphasis on assessment, it seems prudent to evaluate whether our current research and development focus on testing makes sense. Since any intervention within medical education must ultimately be evaluated based upon its impact on student learning, this report seeks to provide a quantitative accounting of the learning gains attained through educational assessments. To approach this question, we estimate achieved learning within a medical school environment that optimally utilizes educational assessments. We compare this estimate to learning that might be expected in a medical school that employs no educational assessments. Effect sizes are used to estimate testing’s total impact on learning by summarizing three effects; the direct effect, the indirect effect, and the selection effect. The literature is far from complete, but the available evidence strongly suggests that each of these effects is large and the net cumulative impact on learning in medical education is over two standard deviations. While additional evidence is required, the current literature shows that testing within medical education makes a strong positive contribution to learning.

The truth lies somewhere in the middle: Swinging between globalization and regionalization of medical education in Japan

Abstract Japan is well known as a super-aging society, with a low birth rate, and has been ranked as one of the countries having the highest quality of healthcare system. Japan’s society is currently approaching a major turning point with regard to societal and healthcare reforms, which are influenced by international trends and regional needs. Development of Japanese healthcare human resources, including medical students, is now expected to ride the wave of globalization, while resolving regional problems in the training and delivery of healthcare. Terms and global trends in medical education, such as outcome-based education, community-based education, reflective learning, international accreditation of medical education, and professionalization of educators are well translated into the Japanese language and embraced positively among the Japanese medical educators. However, these trends occasionally sit uncomfortably with cultural variations that are often a common approach in Japan; notably, “hansei” (introspection) and “kaizen” (change for the better). In the world facing a new era where people are unsettled between globalism and regionalism, Japan’s future mission is to steer a balanced route that recognizes both global and regional influences and produce global health professionals educators.

Medical school choice and quality of undergraduate education

Dear SirWe read with interest Heist and Torok’s article, “A qualitative exploration of the atypical path of Japanese international medical graduates (IMGs)” (Heist and Torok 2018), which provided a...

Listen to the outpatient: qualitative explanatory study on medical students’ recognition of outpatients’ narratives in combined ambulatory clerkship and peer role-play

BackgroundUnderstanding patients’ narratives has been associated with methods of improving care that go beyond what may be regarded as a “narrow” view of scientific medicine. Medical interview training in which medical students develop understanding of the importance of patients’ narratives is receiving increased attention. However, students generally receive education on patients’ narratives that does not distinguish inpatients and outpatients. No studies exploring the characteristics of outpatients’ narratives have been reported. We developed an educational program combining ambulatory clerkship and peer role-play using actual narratives from outpatients that students had encountered during their clerkship. These narratives were used as peer role-play scenarios in which the students acted as outpatients. This study explored what and how medical students learned about the characteristics of outpatients’ narratives through this original educational program.MethodsParticipants were 70 fifth-year medical students from Nagoya University, Japan. We conducted 13 focus groups, based on a convenience sample of 11 groups in 2012, one group in 2013, and one group in 2017 (from 17 clinical groups in each year). Focus group transcripts were analyzed using the “Steps for Coding and Theorization” qualitative data analysis method. We assessed medical anthropological findings regarding narratives in a conceptual framework.ResultsPatients’ narratives as perceived by medical students were divided into four quadrants by two axes: medical versus lived content, and objective versus subjective structure. Students recognized that outpatients’ narratives mainly used a subjective structure, but were mixed and crossed each quadrant. This was described as “irreproducibility.” Students also recognized that narratives of simulated patients and inpatients were mainly limited to a medical-lived content with an objective structure. These differences in narrative characteristics were recognized through students’ previous interactions with simulated patients and inpatients.ConclusionsDespite some limitations, medical students learn about patients’ narratives in our original educational program in a way that would be difficult to achieve through training using simulated patients or inpatients.

Twelve tips for promoting learning during presentations in cross cultural settings

Abstract Educators frequently learn together in cross cultural settings such as at international conferences. Cultural differences should influence how educational programs are designed and delivered to effectively support learning; cultural sensitivity and the competence to deal with such differences are important skills for health professions educators. Teaching without this approach may lead to lost learning opportunities. This article provides twelve tips for educators to consider when planning and delivering formal presentations (e.g. lectures and workshops) in cross cultural settings. The tips were constructed based on a literature review, the authors’ experience, and interviews with international educators who frequently deliver and receive education in cross cultural settings. The tips are divided into three phases: (1) preparation for the session to optimize learners’ experience (2) interaction when delivering the session and (3) reflection on the experience.