Consequences within medical schools for students with poor performance on a medical school standardized patient comprehensive assessment

PURPOSE

Medical schools increasingly employ comprehensive standardized patient assessments to ensure medical students' clinical competence. The consequences of poor performance on the assessment and the institutional factors associated with imposing consequences are unknown.

METHOD

In 2006, the investigators surveyed 122 U.S. medical school curriculum deans about comprehensive assessments using standardized patients after core clerkships, with questions about exam characteristics, institutional commitment to the examination (years of experience, exam infrastructure, clerkship director involvement), academic consequences of failing the assessment, and satisfaction with remediation.

RESULTS

Ninety-three of 122 (76%) deans responded. Eighty-two (88%) conducted a comprehensive assessment in years three or four of medical school. Of those, required remediation was the only consequence of failing employed by 61 schools (74%), and only 39 (47%) required retesting for graduation. Participants were somewhat satisfied with (mean 3.45 out of maximum 5, SD 1.08) and confident in (3.37, SD 1.17) their remediation process. Satisfaction and confidence were associated with requiring remediation (P = .003) and retesting (P < .001), but experience with the exam, exam infrastructure, and clerkship director involvement were not. No school demographic characteristics or measures of institutional commitment were related to external reporting of students' comprehensive assessment scores.

CONCLUSIONS

Despite the prevalence of comprehensive assessments, schools attach few academic consequences to poor performance. Educators are only moderately satisfied with their efforts to remediate poor performers. However, schools with greater trust in their remediation process than other schools are more likely to enforce consequences of poor performance.

Commentary: Assessment is an educational tool

Three articles in this issue, by Bloodgood and colleagues, Hauer and colleagues, and White and colleagues, address important issues in student assessment. They use different approaches to data collection and focus on issues as broad as pass-fail grading in the preclinical years to standardized patient testing and remediation in the clinical years. However, they all remind us that assessment should not be seen as an end in itself, and they underscore the many functions that assessment can play in medical education. Drawing from these three, the authors of this commentary suggest that assessment should be designed to provide useful information for both faculty and students, at the same time minimizing stress and competition and maximizing cooperative learning. The authors assert that assessment data need to be used and that consequences should be attached to performance. In the case of poor performance, the information gained should not be used punitively. Instead, it can be used for support and remediation, giving students tools for self-improvement, assisting them to be self-reflective and gain insight into their strengths and weaknesses, and making them aware of available resources when necessary.

Screening for dyslexia, dyspraxia and Meares-Irlen syndrome in higher education

This study reports a comparison of screening tests for dyslexia, dyspraxia and Meares-Irlen (M-I) syndrome in a Higher Education setting, the University of Worcester. Using a sample of 74 volunteer students, we compared the current tutor-delivered battery of 15 subtests with a computerized test, the Lucid Adult Dyslexia Screening test (LADS), and both of these with data on assessment outcomes. The sensitivity of this tutor battery was higher than LADS in predicting dyslexia, dyspraxia or M-I syndrome (91% compared with 66%) and its specificity was lower (79% compared with 90%). Stepwise logistic regression on these tests was used to identify a better performing subset of tests, when combined with a change in practice for M-I syndrome screening. This syndrome itself proved to be a powerful discriminator for dyslexia and/or dyspraxia, and we therefore recommend it as the first stage in a two-stage screening process. The specificity and sensitivity of the new battery, the second part of which comprises LADS plus four of the original tutor delivered subtests, provided the best overall performance: 94% sensitivity and 92% specificity. We anticipate that the new two-part screening process would not take longer to complete.

A practical perspective on remedial ethics: Minnesota Board of Dentistry

The President and Executive Director of the Minnesota Board of Dentistry describe how the Bebeau course in ethics, for dentists referred because of ethical lapses, is used as part of the disciplinary process in the state. It is understood that breaches of ethical standards are a complex phenomenon, often engaged in by practitioners who know that they are doing wrong but nevertheless choose to do so. Typical patterns of transgression that result in referral to Dr. Bebeau's course include inappropriate billing practices, improper relations with staff or patients, questionable advertising, substandard care, "rough behavior," and gaps in infection control.

Strategies to increase racial/ethnic student participation in the nursing profession

The nursing profession has fewer racial and ethnic minority groups than the United States population, at large (Campbell, n.d.). Racial/ethnic minority students have lower admission and retention rates than White non-Hispanic students. A review of strategies reveals that to recruit and retain racial/ethnic minority students, schools of nursing will have to use interventions that reach diverse student populations, make connections with middle and high school students, support students during the application process, and mentor current students.

The experiences of students with English as a second language in a baccalaureate nursing program

Teaching nursing students with English as a second language (ESL) can be a challenge for nursing faculty in many English speaking countries. This qualitative study purported to answer the research question, "How do students with ESL describe their experiences in a nursing program"? to develop a better understanding of the reasons for their course failure. Seidman's Model of in-depth interviewing (1998) consisting of three successive interviews with the same participant was used. The first interview focused on the students' life histories, the second allowed the participants to reconstruct the details of their experiences, and the third encouraged the students to reflect on the meaning of their experiences. Three themes emerged, "walking the straight and narrow", "an outsider looking in", and "doing whatever it takes to be successful." Although each participant shared instances where ESL may have contributed to his/her academic difficulty, the participants did not perceive that ESL was the primary reason for course failure, but attributed it to the discrimination and stereotyping they experienced. In spite of the discrimination and stereotyping, participants reported a strong desire to persist in the nursing program. Findings from this study provided an in-depth understanding of the perceptions of three nursing students with ESL. Also, the findings are applicable to nursing faculty in that a better understanding of students with ESL can enhance their learning.

The effectiveness of Additional Literacy Support (ALS) in Years 3 and 4

This study compared the progress in reading and spelling of 256 children in 11 classes in 9 English primary schools in Years 3 and 4, and a partially overlapping sample of 126 children who received additional help with literacy during 1 year. Teachers and teaching assistants used either Additional Literacy Support (ALS), a highly structured set of small group teaching materials devised by the English National Literacy Strategy, or a wide variety of other materials including other published intervention programmes, reading scheme-based, computer-based and individually designed interventions, or a combination of ALS and other interventions. The influence of a broad range of contextual factors were investigated, especially whether children's qualities, school factors such as socio-economic status and class size, and delivery differences made significant differences to the outcomes of the different interventions. The study used a naturalistic quasi-experimental design, in which teachers were asked to record details of their children and interventions without altering their professional decisions, which has not been used before in investigating literacy difficulties in context. ALS was marginally more effective than other interventions in the majority of classes, but was clearly superior in value for money terms. Children's qualities did not appear to affect outcomes. Although children receiving additional help made better than average progress, overall catch-up was limited, especially in spelling.

The relationship among mathematics anxiety, beliefs about mathematics, mathematics self-efficacy, and mathematics performance in associate degree nursing students

This research explored nursing students' mathematics anxiety, beliefs about mathematics, and mathematics self-efficacy in relation to performance on a medication mathematics test. Results revealed that the participants experienced some mathematics anxiety and had positive beliefs about mathematics and mathematics self-efficacy. Qualitative responses indicated that participants worried about the consequences of failing the medication mathematics test and that practice helped reduce this anxiety. In addition, participants acknowledged the importance of correct dosage calculations for nursing practice. Implications for nursing education are discussed.

Differentiating the neural response to intervention in children with developmental dyslexia

Developmental dyslexia is associated with functional abnormalities within reading areas of the brain. For some children diagnosed with dyslexia, phonologically based remediation programs appear to rehabilitate brain function in key reading areas (Shaywitz et al., Biological Psychiatry 55: 101-110, 2004; Simos et al., Neuroscience 58: 1203-1213, 2002). However, a non-trivial number of children diagnosed with dyslexia fail to respond to these interventions (Torgesen, Learning Disabilities Research & Practice 15: 55-64, 2000). A cross-sectional fMRI study investigating post-treatment effects was conducted in an effort to better understand differences in brain function between treatment responders and non-responders. Educational testing and brain activation measured after treatment suggested that the reading intervention used in the present study rehabilitated several basic level reading processes in all participants diagnosed with dyslexia. However, activation in the left inferior parietal lobe differentiated treatment responders and non-responders in comparison to non-impaired readers. Children with persistent deficits in single word decoding (treatment non-responders) demonstrated significantly less activation in the left inferior parietal lobe when compared to non-impaired readers.

The influence of cognitive rehabilitation on cognitive competence in patients with Alzheimer's disease

The development of dementia in Alzheimer's disease is known to be influenced by various factors. The research was carried out on 16 patients with a probable diagnosis of Alzheimer's disease (AD), who were first evaluated with MMSE. The patients were then divided according to gender, age, and the progress of the illness into two equal groups. The first group of patients was assigned an additional cognitive therapy for improving cognitive abilities alongside regular treatment while the second group was assigned only regular treatment. After 6 months the patients were re-evaluated using MMSE. The results show a statistically significant difference in cognitive abilities between the two groups with regard to the pre-therapy results. The results of the research are consistent with the results of other researches which imply a slower decrease in cognitive abilities in AD patients who are mentally active.

Fluency remediation in dyslexic children: does age make a difference?

This study tested the hypothesis whether older dyslexic children may obtain fewer gains on fluency and accuracy with respect to their younger peers after specific remediation.Changes in accuracy and fluency of a group of children with a diagnosis of dyslexia attending third and fourth grades were compared with those obtained by a group of children attending the sixth, seventh or eighth grade in two different treatments, one based on the Balance model (Bakker) and the second based on the automatization of syllable recognition (sublexical).Among all comparisons between the gains in accuracy and fluency obtained by the two groups, only the younger group in the sublexical treatment obtained a statistically significant gain with respect to their older peers' accuracy in reading words.These outcomes suggest that, at least for the chronological ages and types of treatments considered in this study, older children with dyslexia may obtain comparable gains to their younger peers, suggesting that 'it is never too late' to remediate reading fluency and accuracy.

Voices of Hispanic students in baccalaureate nursing programs: are we listening?

Hispanics have been described as the "missing persons" in the health professions at a time when a lack of cultural diversity in the workforce has been linked to health disparities. The shortage of Hispanic nurses cannot be addressed effectively without understanding their perspectives on nursing and nursing education. The adapted Model of Institutional Support served as a framework to describe perceived barriers and supports to retention among Hispanic students in baccalaureate nursing programs. Focus groups were used to allow the voices of Hispanic students to emerge; 14 Mexican American nursing students from two liberal arts universities participated. Theory-guided content analysis of focus group transcripts revealed themes congruent with the model components of finances, emotional and moral support, professional socialization, mentoring, academic advising, and technical support. Personal determination emerged as a theme not identified in the model. The prominence of the personal determination theme among these students warrants further study, but suggests that success may be enhanced by helping students capitalize on their personal determination.

Diagnosis and treatment of reading disabilities based on the component model of reading: an alternative to the discrepancy model of LD

Currently, learning disabilities (LD) are diagnosed on the basis of the discrepancy between students' IQ and reading achievement scores. Students diagnosed with LD often receive remedial instruction in resource rooms. The available evidence suggests that the educational policy based on this discrepancy model has not yielded satisfactory results. This has led researchers to try other paradigms, such as the component model and response to intervention, for dealing with children with reading disabilities. The component model of reading (CMR) described in the present article identifies the reading component that is the source of reading difficulty and targets instruction at that component. Study 1 describes the CMR and reports on its validity. Study 2 describes the successful outcome of a 7-year CMR-based reading instruction program. Compared to the discrepancy model, the CMR has demonstrated several advantages.

Computer-based spelling instruction for students with developmental disabilities

Learning to spell on the computer may lead to functionally useful writing skills. Alan and Suzy, teenagers with developmental disabilities, were already proficient on a variety of naming and matching tasks but had difficulties spelling; Suzy also made errors reading orally. In Experiment 1, computer teaching led to new anagram and written spelling performances. Suzy's reading also improved. On tabletop tasks, Alan and Suzy sorted and retrieved objects to a list they wrote and read aloud. When the tabletop tasks were repeated weeks later, Alan's spelling accuracy declined but Suzy's was nearly perfect. In Experiment 2, using a different and refined teaching format, Alan relearned his old words and Suzy learned to spell new words. Immediately afterwards, and weeks later, both Alan and Suzy performed nearly perfectly on the tabletop matching, sorting, and reading tasks. The results replicate previous research and extend it with a refined package of computer methods that establishes durable and potentially functional writing skills. The possibility that learning to spell also improves oral reading is worthy of further research.

Cognitive characteristics of children with mathematics learning disability (MLD) vary as a function of the cutoff criterion used to define MLD

Researchers of mathematics learning disability (MLD) commonly use cutoff scores to determine which participants have MLD. Some researchers apply more restrictive cutoffs than others (e.g., performance below the 10th vs. below the 35th percentile). Different cutoffs may lead to groups of children that differ in their profile of math and related skills, including reading, visual-spatial, and working memory skills. The present study assesses the characteristics of children with MLD based on varying MLD definitions of math performance either below the 10th percentile (n = 22) or between the 11th and 25th percentile (n = 42) on the Test of Early Math Ability, second edition (TEMA-2). Initial starting levels and growth rates for math and related skills were examined in these two MLD groups relative to a comparison group (n = 146) whose TEMA-2 performance exceeded the 25th percentile. Between kindergarten and third grade, differences emerged in the starting level and growth rate, suggesting qualitative differences among the three groups. Despite some similarities, qualitative group differences were also observed in the profiles of math-related skills across groups. These results highlight differences in student characteristics based on the definition of MLD and illustrate the value of examining skill areas associated with math performance in addition to math performance itself.

Developing Students' Writing Skills

In what seems to be a universal situation, nurse educators are reading student papers and lamenting the fact that their students cannot write. The author explains a successful model of early intervention aimed at improving academic writing for new graduate students. The model and teaching strategies are helpful to nurse educators who struggle with the quality of their students' written work.

Diversity and the NCLEX-RN: a double-loop approach

The United States is increasingly ethnically diverse. To provide culturally congruent care to this changing population, nursing programs must attract and support ethnically diverse students through to successful completion of the National Council Licensure Examination for Registered Nurses. Critically examining the literature on this topic revealed three themes: need for a diverse nursing workforce, lack of formal evidence, and narratives of concern. A double-loop theoretical approach that encompasses interventions in elementary and secondary schools, traditional student support services, faculty development initiatives focused on cultural competence, formative and summative evaluations, quantitative and qualitative research, and evidence-based interventions is proposed to address this multifaceted concern.

The influence of instruction modality on brain activation in teenagers with nonverbal learning disabilities: two case histories

Teenagers with nonverbal learning disabilities (NLD) have difficulty with fine-motor coordination, which may relate to the novelty of the task or the lack of "self-talk" to mediate action. In this study, we required two teenagers with NLD and two control group teenagers to touch the thumb of each hand firmly and accurately to the fingertips of the same hand, in an order specified by verbal or tactile instruction. Brain activity patterns (measured using functional magnetic resonance imaging) suggest that unlike control participants, the NLD participants used internalized speech to facilitate the novel task only when instructions were verbal. NLD participants also showed activity in a more widely distributed network of neural structures. These findings provide preliminary evidence for remediation strategies that encourage internal speech.

Teaching Struggling Readers Who Are Native Spanish Speakers: What Do We Know?

Purpose

The purpose of this article is to share what we have learned from a series of 4 scientific studies about preventing reading failure through early intervention with native Spanish-speaking students who are struggling readers. The goal is to provide guidance to practitioners about effective practices for working with native Spanish-speaking children who are struggling to become readers using evidence rather than conjecture and opinion.

Method

First, the method and findings are summarized from each of 4 scientific studies (2 English, 2 Spanish) examining supplemental reading intervention that was provided in addition to core reading instruction in first grade. Second, the supplemental interventions are detailed. Next, aspects of instruction that appear to generalize from what we know about preventing reading failure among native English speakers are discussed. Last, the types of adjustments made to this instruction in order to accommodate the needs of English language learners are examined.

Implications

Outcomes confirm that native Spanish-speaking children benefited from explicit, systematic instruction that shared many of the same elements that have been proven to be effective with native English speakers. Further, English as a second language teaching techniques (i.e., use of concrete gestures and visual aids, consistent and repeated routines, and use of repeated phrases and consistent language) benefited native Spanish speakers who were struggling to learn to read in English. However, little transfer of knowledge from one language to another was detected.

Computer speech-based remediation for reading disabilities: the size of spelling-to-sound unit in a transparent orthography

This study was designed to assess the effects of four reading-training procedures for children with reading disabilities (RD) in a transparent orthography, with the aim of examining the effects of different spelling-to-sound units in computer speech-based reading. We selected a sample of 83 Spanish children aged between 7 years 1 month and 10 years 6 months (M = 105.2, SD = 7.8) whose pseudoword reading performance was below the 25th percentile and IQ > 90. The participants were randomly assigned to five groups: (a) the whole-word training group (WW) (n = 17), (b) the syllable training group (S)(n = 16), (c) the onset-rime training group (OR) (n = 17), (d) the phoneme training group (P) (n = 15), and (e) the untrained control group (n = 18). Children were pre- and post-tested in word recognition, reading comprehension, phonological awareness, and orthographic and phonological tasks. The results indicate that experimental groups who participated in the phoneme and syllable conditions improved their word recognition in comparison with the control group. In addition, dyslexics who participated in the phoneme, syllable, and onset-rime conditions made a greater number of requests during computer-based word reading under conditions that required extensive phonological computation (low frequency words and long words). Reading time, however, was greater for long words in the phoneme group during computer-based reading. These results suggest the importance of training phonological processes in improving word decoding in children with dyslexia who learn in a consistent orthography.

Reliability of multiple-component measuring instruments: improved evaluation in repeated measure designs

A covariance structure analysis method for improved point and interval estimation of composite reliability in repeated measure designs is outlined that accounts for specificity variance. The approach also permits the testing of time-invariance in reliability of multiple-component instruments in terms of the ratio of 'pure' measurement error variance to observed scale score variance. In addition, the procedure allows interval estimation of the difference in composite reliability coefficients across assessment occasions. The method described is illustrated with data from a cognitive intervention study.

Computerized screening for visual stress in children with dyslexia

Visual stress-a condition in which unpleasant visual symptoms are experienced when reading-has been reported to be more prevalent in dyslexic individuals but at the present time the relationship between dyslexia and visual stress remains controversial. ViSS, a computerized visual stress screener that incorporates reading-like visual search, has recently shown promise in studies with unselected samples of primary and secondary school children. This study investigated the use of ViSS with dyslexic children. Dyslexic children identified as having high visual stress showed significantly higher per cent increases in reading rate with a coloured overlay and reported significantly higher critical symptoms of visual stress, compared to dyslexic children with low visual stress. The same results were found for reading-age controls, indicating that ViSS can be equally effective with normal readers as well as with children with dyslexia. Compared to reading-age controls, dyslexic children were found to have significantly higher susceptibility to visual stress, significantly larger per cent increases in reading rate with an overlay, and significantly higher critical and non-critical symptoms of visual stress. Extrapolated to unselected population samples, the data also suggest that visual stress is more likely to be found in people with dyslexia than in people who do not have dyslexia. These results, which point to an important link between the two conditions, are discussed in relation to current theories that attribute visual stress to either a magnocellular dysfunction or cortical hyperexcitability.

Follow-up of an exercise-based treatment for children with reading difficulties

This study reports the results of a long-term follow-up of an exercise-based approach to dyslexia-related disorders (Reynolds, Nicolson, & Hambly, Dyslexia, 2003; 9(1): 48-71). In the initial study, children at risk of dyslexia were identified in 3 years of a junior school. One half then undertook a 6 month, home-based exercise programme. Evaluation after 6 months indicated that the exercise group improved significantly more than the controls on a range of cognitive and motor skills. Critics had suggested that the improvement might be attributable to artifactual issues including Hawthorne effects; an initial literacy imbalance between the groups; and inclusion of non-dyslexic participants. The present study evaluated the issue of whether the gains were maintained over the following 18 months, and whether they were in some sense artifactual as postulated by critics of the original study. Comparison of (age-adjusted) initial and follow-up performance indicated significant gains in motor skill, speech/language fluency, phonology, and working memory. Both dyslexic and non-dyslexic low achieving children benefited. There was also a highly significant reduction in the incidence of symptoms of inattention. Interestingly there were no significant changes in speeded tests of reading and spelling, but there was a significant improvement in (age-adjusted) reading (NFER). It is concluded that the gains were indeed long-lasting, and that the alternative hypotheses based on potential artifacts were untenable, and that the exercise treatment therefore achieved its applied purpose. Further research is needed to determine the underlying reasons for the benefits. Possible (and potentially synergistic) explanations include: improved cerebellar function (neural level); improved learning ability and/or attentional ability (cognitive level); improved self-esteem and self-efficacy (affective level); and improved parental/familial support (social level).