Using educational prescriptions to teach medical students evidence-based medicine.

Purpose: To evaluate feasibility and impact of evidence-based medicine (EBM) educational prescriptions (EPs) in medical student clerkships.

Methods: Students answered clinical questions during clerkships using EPs, which guide learners through the "four As" of EBM. Epidemiology fellows graded EPs using a rubric.

Single and Multiple Ability Estimation in the SEM Framework: A Non-Informative Bayesian Estimation Approach.

Latent variable models with many categorical items and multiple latent constructs result in many dimensions of numerical integration, and the traditional frequentist estimation approach, such as maximum likelihood (ML), tends to fail due to model complexity. In such cases, Bayesian estimation with diffuse priors can be used as a viable alternative to ML estimation. The present study compares the performance of Bayesian estimation to ML estimation in estimating single or multiple ability factors across two types of measurement models in the structural equation modeling framework: a multidimensional item response theory (MIRT) model and a multiple-indicator multiple-cause (MIMIC) model.

Commentary: measurement and interpretation challenges in comparing student performance outcomes from different medical schools.

This commentary points to several measurement issues that arise in assessing medical student performance outcomes and then discusses the challenge of interpreting between-school differences. A problem often encountered in assessing student learning is creating an instrument that is at the right "pay grade." If it is too easy, ceiling effects compress scores.

Impact of physician assistant care on office visit resource use in the United States.

Objective: To investigate whether the use of physician assistants (PAs) as providers for a substantive portion of a patient's office-based visits affects office visit resource use.

Data Source: Medical Expenditure Panel Survey (MEPS) Household Component data from 1996 to 2004.

Study Design: This retrospective cohort study compares the number of office-based visits per year between adults for whom PAs provided >or=30 percent of visits and adults cared for by physicians only.

Diagnostic radiology resident compliance with recommended health guidelines: effect of resident work environment.

Rationale And Objectives: To determine diagnostic radiology resident compliance with recommended health guidelines for physical activity, body weight, diet, related health indicators, and the effects of the resident work environment on compliance.

Materials And Methods: A request was electronically mailed to members of the Association of Program Directors in Radiology and the Association of Program Coordinators in Radiology in May 2007 and again in June 2007, asking members to forward to their radiology residents an invitation to complete an online health survey. Frequency counts and Fisher's exact test, respectively, were used to summarize results and to determine statistically significant relationships between survey variables.

Building a competency-based curriculum: the agony and the ecstasy.

Physician competencies have increasingly been a focus of medical education at all levels. Although competencies are not a new concept, when the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS) jointly agreed on six competencies for certification and maintenance of certification of physicians in 1999, it brought about renewed interest. This article gives a brief overview of how a competency-based curriculum differs from other approaches and then describes the issues that need to be considered in the design and implementation of such a curriculum.

Defining characteristics of educational competencies.

Context: Doctor competencies have become an increasing focus of medical education at all levels. However, confusion exists regarding what constitutes a competency versus a goal, objective or outcome.

Objectives: This article attempts to identify the characteristics that define a competency and proposes criteria that can be applied to distinguish between competencies, goals, objectives and outcomes.

Missing in action: care by physician assistants and nurse practitioners in national health surveys.

Objective: To assess applicability of national health survey data for generalizable research on outpatient care by physician assistants (PAs) and nurse practitioners (NPs).

Data Sources: Methodology descriptions and 2003 data files from the National Ambulatory Medical Care Survey, the National Hospital Ambulatory Medical Care Survey, the Medical Expenditure Panel Survey, and the Community Tracking Study.

Study Design: Surveys were assessed for utility for research on PA and NP patient care, with respect to survey coverage, structure, content, generalizability to the U.

Statistical criteria for setting thresholds in medical school admissions.

In 2001, Dr Jordan Cohen, President of the AAMC, called for medical schools to consider using an Medical College Admission Test (MCAT) threshold to eliminate high-risk applicants from consideration and then to use non-academic qualifications for further consideration. This approach would seem to be consistent with the recent Supreme Court ruling on the University of Michigan admissions cases. Research to support a threshold approach has been reported in many different ways, making comparability problematic.

A comparison of statistical criteria for setting optimally discriminating MCAT and GPA thresholds in medical school admissions.

Background: Using Medical College Admission Test-grade point average (MCAT-GPA) scores as a threshold has the potential to address issues raised in recent Supreme Court cases, but it introduces complicated methodological issues for medical school admissions.

Purpose: To assess various statistical indexes to determine optimally discriminating thresholds for MCAT-GPA scores.

Methods: Entering classes from 1992 through 1998 (N = 752) are used to develop guidelines for cut scores that optimize discrimination between students who pass and do not pass the United States Medical Licensing Examination (USMLE) Step 1 on the first attempt.

Patient, faculty, and self-assessment of radiology resident performance: a 360-degree method of measuring professionalism and interpersonal/communication skills.

Rationale And Objectives: To develop and test the reliability, validity, and feasibility of a 360-degree evaluation to measure radiology resident competence in professionalism and interpersonal/communication skills.

Materials And Methods: An evaluation form with 10 Likert-type items related to professionalism and interpersonal/communication skills was completed by a resident, supervising radiologist and patient after resident-patient interactions related to breast biopsy procedures. Residents were also evaluated by faculty, using an end-of-rotation global rating form.

Matriculating student perceptions of changes to the admissions interview process at the University of Wisconsin Medical School: a prospective, controlled comparison.

Purpose: The purpose of this study was to assess whether changes in the admissions interview process improved matriculating students' perceptions of the quality of the admissions interview process.

Methods: We surveyed matriculating medical students for a 3-year period. Over this period, the admissions process and procedures went through a review and then a re-engineering.

Assessing personal qualities in medical school admissions.

The authors analyze the challenges to using academic measures (MCAT scores and GPAs) as thresholds for admissions and, for applicants exceeding the threshold, using personal qualities for admission decisions; review the literature on using the medical school interview and other admission data to assess personal qualities of applicants; identify challenges of developing better methods of assessing personal qualities; and propose a unified system for assessment. The authors discuss three challenges to using the threshold approach: institutional self-interest, inertia, and philosophical and historical factors. Institutional self-interest arises from the potential for admitting students with lower academic credentials, which could negatively influence indicators used to rank medical schools.

Teaching radiology to medical students: an integrated approach.

Rationale And Objectives: This study assessed medical student satisfaction with radiology lectures integrated into the 3rd-year student internal medicine clerkship, compared with faculty lectures in an independent radiology course, and investigated the effects of integrated instruction on departmental compensation from the medical school.

Materials And Methods: Students' evaluations were compared, with two-way analysis of variance, for faculty who presented lectures in an integrated radiology course and faculty who presented lectures in an independent radiology course from July 1998 to June 2001. Radiology department compensation from the medical school for each course was computed per contact hour.