MRCGP CSA: are the examiners biased,favouring their own by sex,ethnicity, and degree source?

Background

Concern exists regarding differential performance of candidates in postgraduate clinical assessments by ethnicity, sex, and country of primary qualification. Could examiner bias be responsible?

Aim

To explore whether candidate demographics affect examiners’ judgements, by investigating candidates’ case performances by candidates’ and examiners’ demographics.

Design and setting

Data on 4000 candidates (52 000 cases) sitting the MRCGP clinical skills assessment in 2011–2012.

Method

Univariate analyses were undertaken of subgroup performance (male/female, white/black and minority ethnic (BME), UK/non-UK graduates) by parallel examiner demographics. Due to confounding of variables, these were complemented by multivariate ANOVA and multiple regression analyses.

Results

Univariate analysis showed some differences between outcomes between the same-group and other-group examiners: these were contradictory regarding examiners ‘favouring their own’, for example, males received higher marks from female examiners than from males: maximum effect size was 3.6%. A six-way ANOVA confirmed all three candidate and examiner variables as having significant effects individually, identifying one significant interaction (examiner sex by examiner ethnicity). Stepwise regression showed candidate variables predicting 12% of score variance, parallel examiner demographics adding little (approximately 0.2% of variance). One ‘transactional’ variable proved significant, explaining 0.06% of score variance.

Conclusion

Examiners show no general tendency to ‘favour their own kind’. With confounding between variables, as far as the impact on candidates’ case scores, substantial effects relate to candidate and not examiner characteristics. Candidate–examiner interaction effects were inconsistent in their direction and slight in their calculated impact.     

Keeping the body in mind: A qualitative analysis of the experiences of people experiencing first‐episode psychosis participating in a lifestyle intervention programme

The life expectancy gap experienced by people living with severe mental illness is primarily a result of cardiometabolic disease that is often exacerbated by side effects of antipsychotic medication. Commencement of atypical antipsychotic medication is commonly associated with weight gain. The Keeping the Body in Mind programme has demonstrated that early intervention with lifestyle activities can attenuate this weight gain and potentially improve long‐term health outcomes. The aim of this study was to explore the experiences of young people who participated in the Keeping the Body in Mind programme, a targeted lifestyle intervention programme. A qualitative approach was used employing a semi‐structured interview format. The interview schedule included questions related to four topics: aspects of the programmes that were useful, attributes of staff members that influenced the programme, changes in attitudes towards their own physical health, and suggestions for programme improvements. Interviews were recorded with duration ranging from 40 to 65 min. Thematic analysis was used to detect and assemble codes. These were then synthesized and classified into themes. Eleven participants were interviewed (seven males), aged between 18 and 25 years. Thematic analysis revealed four main themes: the role of physical health in mental health recovery; the importance of staff interactions; the value of peer interaction; and graduation to a sustainable healthy lifestyle. Study participants reported that they valued the programme for both their physical health and mental health recovery.     

Postpartum moods in men and women

Twenty-one married couples, recruited from childbirth classes (mean age 29.6 years), were administered questionnaires measuring 20 different moods during the third trimester of pregnancy (prepartum period), during the postpartum period, and at 6 months after birth (follow-up period). In each questionnaire period individual questionnaires were filled out daily by both the mother and father for 10 consecutive days. The results indicated that the postpartum period, compared with the prepartum and follow-up periods, is an emotionally unique time but not a period marked by depression. The moods that were rated as being experienced more strongly by men and women during the postpartum period were associated with anxiety and concern for one's ability to cope such as "nervousness," "worried," "helpless," and "anxious" or positive emotions such as "enthusiastic" and "happy." It is concluded that men and women in this sample tend to experience the postpartum period in an emotionally similar way.     

Endorsement of irrational beliefs as a moderator of the effects of stressful life events

Rational-emotive theory would predict that beliefs mediate the relationship between potentially stressful events and subsequent distress. On the basis of this prediction, the present study examined the role of endorsement of irrational beliefs as a moderator of the relationship between stressful life events and psychological and physical distress. Consistent with previous research, irrational beliefs and life changes were found to make significant unique predictions of both psychological and physical distress. Furthermore, endorsement of irrational beliefs moderated the relationship between life changes and physical distress, but not the relationship between life changes and psychological distress.     

Comparison of 85Sr, 87mSr, 18F, and 99mTc-labeled phosphates for bone scanning.

The observation by Subramanian and his co-workers that a 99mTc-labeled polyphosphate had excellent affinity for bone has led to widespread use of 99mTc-labeled phosphates as bone scanning agents. Initially, only polyphosphate was employed, but because of somewhat inconstant results and difficulty in preparation of this product, other phosphate compounds were sought. We soon discovered that an inorganic compound, pyrophosphate, appeared to have certain advantages over polyphosphate. Other workers formulated diphosphonates (organic phosphates) which also demonstrated advantages over polyphosphates. Comparison studies in rabbits utilizing 85Sr, 87mSr, 18F, and several phosphates (inorganic and organic) proved the 99mTc-labeled phosphates to be clearly superior in delineating normal skeletal anatomy. Studies in humans confirmed that excellent visualization of bone was obtained with 99mTc-labeled phosphates using either a gamma camera or a rectilinear scanner. What was not known, however, was just how reliable this class of agents would prove to be in detecting bone disease when compared to bone-seeking radiopharmaceuticals such as 85Sr, 87mSr, and 18F. Further comparative analyses have clearly demonstrated that both inorganic and organic 99mTc phosphate complexes are extremely sensitive in revealing more bone disease than the older bone scanning agents.     

Self-control of dysmenorrheic symptoms through pain management training

An adaptation of Anxiety Management Training was evaluated as a means of teaching women to use relaxation in order to control menstrual pain and discomfort. After reporting their menstrual symptoms for two successive baseline periods, spasmodic and congestive dysmenorrheic subjects received four individual sessions of pain management training. Following treatment, these subjects reported significant reductions in pain, discomfort, interference, and time loss due to dysmenorrheic symptoms relative to their own baselines and to an untreated control group. These effects were still in evidence 18 months after treatment and appeared to have generalized to behavioral, attentional and autonomic symptoms that might be considered secondary sequelae of dysmenorrhea. With one minor exception, there was no differential response to treatment by spasmodic as opposed to congestive subjects.     

Localization of distinct monoamine oxidase A and monoamine oxidase B cell populations in human brainstem

Monoclonal antibodies, specific for either monoamine oxidases A or B, were used to determine the localization of monoamine oxidase in the human brain. Two distinct populations of neurons were detected by immunocytochemical staining. Neurons in regions rich in catecholamines were positive for monoamine oxidase A, including the nucleus locus coeruleus, the nucleus subcoeruleus and the medullary reticular formation. In these regions, monoamine oxidase A could be co-localized with the synthetic enzyme, dopamine-beta-hydroxylase. Neurons in the substantia nigra and the periventricular region of the hypothalamus, areas rich in dopamine neurons, stained for monoamine oxidase A but with much less frequency and intensity. The major accumulation of monoamine oxidase B-positive neurons was observed in the same regions in which monoamine oxidase B is found to co-localize with serotonin in monkey tissues, including the nucleus raphe dorsalis and the nucleus centralis superior. In addition, both monoamine oxidase A and B were localized in distinct populations of neurons in the lateral and tuberal regions of the hypothalamus, a region shown recently to contain histamine neurons in rats. Some glial cells were stained throughout the brain for monoamine oxidase A or B suggesting that glia are capable of either expression or uptake of these proteins.     

Bacterial vaginosis: A problematic infection from both a perinatal and neonatal perspective

Bacterial vaginosis (BV) infections are common in women of reproductive age and are easily diagnosed and treatable. Aside from being an annoyance when symptoms of discharge, odor, and pruritus occur in the gravid female, BV infections increase risk of late miscarriage, preterm labor, preterm premature rupture of membranes, and, consequently, preterm delivery. Antepartum and puerperal issues such as chorioamnionitis and endometritis are increased in the context of maternal BV. Moreover, the morbidities and mortality of preterm delivery are consequently increased as a result of BV during pregnancy. Although the pathology associated with BV appears to result from inflammation, more investigation is needed in terms of designing guidelines for appropriate screening and treatment for the prevention of adverse outcomes.