Utility of selection methods for specialist medical training: A BEME (best evidence medical education) systematic review: BEME guide no. 45

Background: Selection into specialty training is a high-stakes and resource-intensive process. While substantial literature exists on selection into medical schools, and there are individual studies in postgraduate settings, there seems to be paucity of evidence concerning selection systems and the utility of selection tools in postgraduate training environments.

Aim: To explore, analyze and synthesize the evidence related to selection into postgraduate medical specialty training.

Method: Core bibliographic databases including PubMed; Ovid Medline; Embase, CINAHL; ERIC and PsycINFO were searched, and a total of 2640 abstracts were retrieved. After removing duplicates and screening against the inclusion criteria, 202 full papers were coded, of which 116 were included.

Results: Gaps in underlying selection frameworks were illuminated. Frameworks defined by locally derived selection criteria, and heavily weighed on academic parameters seem to be giving way to the evidencing of competency-based selection approaches in some settings.

Regarding selection tools, we found favorable psychometric evidence for multiple mini-interviews, situational judgment tests and clinical problem-solving tests, although the bulk of evidence was mostly limited to the United Kingdom. The evidence around the robustness of curriculum vitae, letters of recommendation and personal statements was equivocal. The findings on the predictors of past performance were limited to academic criteria with paucity of long-term evaluations. The evidence around nonacademic criteria was inadequate to make an informed judgment.

Conclusions: While much has been gained in understanding the utility of individual selection methods, though the evidence around many of them is equivocal, the underlying theoretical and conceptual frameworks for designing holistic and equitable selection systems are yet to be developed.     

Learning to balance efficiency and innovation for optimal adaptive expertise

Abstract

It is critical for health professionals to continue to learn and this must be supported by health professions education (HPE). Adaptive expert clinicians are not only expert in their work but have the additional capacity to learn and improve in their practices. The authors review a selective aspect of learning to become an adaptive expert: the capacity to optimally balance routine approaches that maximize efficiency with innovative ones where energy and resources are used to customize actions for novel or difficult situations. Optimal transfer of learning, and hence the design of instruction, differs depending on whether the goal is efficient or innovative practice. However, the task is necessarily further complicated when the aspiration is an adaptive expert practitioner who can fluidly balance innovation with efficiency as the situation requires. Using HPE examples at both the individual and organizational level, the authors explore the instructional implications of learning to shift from efficient to innovative expert functioning, and back. They argue that the efficiency-innovation tension is likely to endure deep into the future and therefore warrants important consideration in HPE.     

Diazotised [125I]iodosulphanilic acid is not a marker for the outer bilayer of the tegument of adult Schistosoma mansoni

Diazotised [125I]iodosulphanilic acid (DISA), has been used to label the tegument surface of adult male Schistosoma mansoni in vitro. In a surface membrane fraction prepared by freeze-thaw, only a negligible amount of lipid material was labelled by DISA, and 15 labelled protein bands were detected, ranging in apparent molecular weight from 21,000 to 175,000. As a result of experiments using digitonin to extract surface material, DISA has been described as a marker for the outer bilayer of the schistosome tegument surface. However, we found that two surface membrane fractions obtained by digitonin extraction, which were expected to be enriched in either outer or inner bilayer, yielded almost identical sodium dodecyl sulphate-polyacrylamide gel electrophoresis autoradiographic patterns, with 13 labelled protein bands (21 to 64 kDa) detected in each. In addition, a large proportion of the label was not bound firmly to the worm surface, and although the intact worm surface restricted the access of the label to membrane proteins, nevertheless proteins of the inner bilayer were labelled. Thus, we conclude that DISA is not a marker for the outer bilayer.     

Two natal maxillary molars. Report of a case.

A 20-day-old black male infant with two rare posterior natal teeth was referred for examination and care. Oral radiographs suggested that the teeth were the right and left maxillary primary molars. The hypermobile teeth and associated suspicious soft tissue masses were removed. Histologic examination revealed irregular tooth structures and infiltrate consistent with inflamed dental follicles.     

Twelve tips for assessment psychometrics

It is incumbent on medical schools to show, both to regulatory bodies and to the public at large, that their graduating students are “fit for purpose” as tomorrow’s doctors. Since students graduate by virtue of passing assessments, it is vital that schools quality assure their assessment procedures, standards, and outcomes. An important part of this quality assurance process is the appropriate use of psychometric analyses. This begins with development of an empowering, evidence-based culture in which assessment validity can be demonstrated. Preparation prior to an assessment requires the establishment of appropriate rules, test blueprinting and standard setting. When an assessment has been completed, the reporting of test results should consider reliability, assessor, demographic, and long-term analyses across multiple levels, in an integrated way to ensure the information conveyed to all stakeholders is meaningful.     

Nonsecular Medical Anthropology

ABSTRACT

A nonsecular medical anthropology insists on the ways medicine and science have constituted ‘the secular’ itself through the ‘secular self’—how medical knowing has been used to craft the secular political subject. As James Boon noted, too often in social theory, “religion gets safely tucked away—restricted theoretically to ‘meaning’ rather than power” (1998:245). The authors of the six articles in this special issue ‘untuck’ religiosity from within the norms and numbers of medicine itself, and examine how ‘secular’ medicine has relied on religious traditions to produce political secularity. These articles demonstrate that ‘secular’ medicine relies on religious others whose exclusion bespeaks latent religious commitments of citizenship in the modern political realm of health.     

Three-dimensional MR imaging of pulmonary vessels and parenchyma with NC100150 injection (Clariscan)

The influence of increasing doses of NC100150 Injection (Clariscantrade mark) and echo times on visualization of pulmonary vessels and parenchyma was evaluated. The effects of 0.5, 1, 2, 4, and 8 mg Fe/kg NC100150 Injection and echo times (TE) of 1.1, 1.8, 2. 2, and 4.3 msec were determined in six dogs using breath-hold three-dimensional (3D) spoiled gradient-echo magnetic resonance (MR) sequence. At 2 mg Fe/kg and TE of 1.1 msec, the signal-to-noise ratio of the central pulmonary arteries and parenchyma was significantly increased (5.3 +/- 2.2 to 50.3 +/- 2.4) and (2.2 +/- 0. 9 to 6.4 +/- 1.1), respectively. Using the TE of 1.1 msec, signal intensity in the main arteries continued to increase with increasing dose. Moreover, the enhancement of pulmonary parenchyma and microvasculature had a positive dose response. 3D MR imaging with ultrashort echo time and 2 mg Fe/kg NC100150 Injection produces angiograms with strong vascular contrast and allows qualitative assessment of pulmonary parenchyma and microvasculature.     

Evaluation of a computerised test for the assessment of peripheral vascular disease

This paper reports a study carried out in 200 patients to assess the effectiveness of a clinical vascular laboratory in the routine assessment of peripheral vascular disease (PVD) of the lower limb. Laboratory assessments involved a computer based hierarchical testing system incorporating pedal pressure indices, maximum walking distances and principal component analysis of the common femoral artery blood velocity waveform. The study fell into two parts. In the first, the laboratory assessments of 100 patients referred six years ago were compared retrospectively with their eventual clinical outcome. In this comparison, the laboratory provided a "diagnosis" which was 79% correct. In the second, a double blind prospective study was carried out in 100 patients to compare the vascular laboratory "diagnosis" with the diagnosis and prognosis of a skilled clinician, the outcome being compared one year after the initial assessment. In this study the laboratory proved to be correct in 78% of cases, the clinician in 70%. With a slightly modified computer protocol for the non vascular diagnosis, the computer would have been correct in 85% of cases. This test provides a quantitative and objective assessment of PVD which can assist in the patient's clinical diagnosis and management.