Relationship between admission selection tools and student attrition in the early years of medical school

Objectives

Placement in medical schools is highly sought after worldwide with fierce competition among applicants. However, some of the best students withdraw after being accepted to medical school. The aim of this study was to investigate early student attrition within the first 2 years of medical school and determine its relationship to admission selection tools.

Methods

Quantitative research was conducted at the College of Medicine and Health Sciences from 2016 until 2020, during which time routine admission data and students' examination results for the first 2 years were collected and analyzed.

Results

The attrition rate during the study period was 31.7%. High school and college written examination scores were significantly related to completing the premedical program (p = 0.001 and p = 0.002, respectively). Female students scored significantly higher in multiple mini interviews (MMIs) compared with male counterparts (p < 0.001). However, the difference in MMI score was not related to student attrition (p = 0.148).

Conclusion

The cause of early attrition is complex and cannot be attributed to a single factor.Undergraduate high school score and written admission examination results were statistically significant factors in relation to student attrition rate and low academic performance. The results of this study showed that the female students scored significantly higher in the multiple MMI tests compared to male students. However, MMI score alone was not significantly related to student attrition.

Integrating the social determinants of health into curriculum: AMEE Guide No. 162

The World Health Organization (WHO) defines the Social Determinants of Health (SDOH) as the non-medical factors influencing health outcomes. SDOH is associated with conditions in which people are born, grow, work, and live. Medical schools and licensing bodies are increasingly recognizing the need for doctors and healthcare professionals to be aware of their patient's social context and how it impacts their states of health and disease. However, there is considerable variation in the approaches of different institutions and countries to incorporating SDOH into their curricula. In order to allow clinicians to adopt a holistic approach to patient health, equipping them with extensive knowledge of SDOH would give learners the confidence, skills, knowledge, and attitudes needed to effectively engage with patients and their families. This approach aids health professionals with knowledge of the influence of the social context and cultural factors that affect patients' behaviors in relation to health. Incorporating the SDOH in medical and health professional school curricula would contribute towards adequately preparing future healthcare practitioners to provide effective, comprehensive, and equitable care, especially to marginalized and underserved populations. The Guide will take an evidence-based approach grounded in the available contemporary literature and case studies. The focus will be on integrating SDOH into undergraduate and postgraduate medical curricula to promote an understanding of the social factors that influence patients' and communities' health. Ultimately, this guide seeks to contribute to the reduction of inequalities in health.

Practical Guide to Undergraduate Medical Curriculum Alignment and Mapping

Objective

Curriculum development and reviews are of paramount importance for academic programs curriculum management. Medical curricula need proper construction and frequent updates to suits learning outcomes considering their integrative nature and rapid scientific advancement. Curriculum alignment and mapping are fundamental for proper integration and planning of medical curriculum. This process is beneficial in detecting gaps and redundancies, and ensuring proper instruction, integration, and transparency. However, there is a paucity in the literature of a practical guidance to such process. Hence, this manuscript provides a practical guidance that was adopted in our institutes.

Methods

A detailed description of twelve step-by-step guidance to curriculum alignment and mapping was provided. The process needed for each step and the flow chart of work was detailed.

Results

This guide was developed and implemented successfully. Among many benefits encountered, many gaps in the contents, learning outcomes and assessment methods were detected and rectified. Additionally, better curriculum integration has been achieved. The current mapping will make any future curriculum reviews easier.

Conclusion

This guide could be utilized by newly developed and existing programs for curriculum alignment and mapping. It fills a gap in academic literature through stepwise workflow which has been tested and implemented.

Assessing relational coordination and its impact on perceived mental health of students, teachers and staff in a clinical skills program during the COVID-19 pandemic

BACKGROUND

The global spread of the COVID-19 virus caused unprecedented interruptions in medical education. This paper evaluates Relational Coordination (RC): communicating and relating for task integration; between the distinct stakeholders responsible for scheduling,delivering and receiving clinical teaching in the wake of the pandemic.

METHODOLOGY

Using a cross-sectional design, the level of Relational Coordination was assessed between twelve groups within a Clinical Skills Program at a Medical School in the United Arab Emirates. It also measures three relevant mental health factors: namely, Job satisfaction, Work Engagement, and Burnout.

RESULTS

Overall, RC scores were moderate (3.65 out of 5.00). Controlling for participants' position, RC was found to positively and significantly increase both job satisfaction (β = 1.10, p < 0.001) and work engagement (β = 0.78, p < 0.01)., Additionally, RC was significantly associated with lower burnout (β = -0.56, p = 0.05). Fifty percent of participants experienced high job satisfaction, with a mean score of 5.0 out of 7.0, while 73% reported being enthusiastic about their job, with a mean score of 6.0 out of 7.0. About a third of participants (27%) reported feeling burnout.

CONCLUSIONS

During times of disruption and crisis, medical education can benefit from higher levels of relational coordination. Our study shows the significant impact of relational coordination on mental health measures like job satisfaction and work engagement. To achieve the full potential and benefits of excellent levels of relational coordination in this program, we recommend six interventions focusing on improving communication, work processes, regular meetings, education innovations, capacity building, and the establishment of coaching and counseling programs for students and faculty.

Failure to demonstrate effects of interruptions on diagnostic reasoning: three experiments

BACKGROUND

Diagnostic error is a major source of patient suffering. Researchshows that physicians experience frequent interruptions while being engaged with patients and indicate that diagnostic accuracy may be impaired as a result. Since most studies in the field are observational, there is as yet no evidence suggesting a direct causal link between being interrupted and diagnostic error. Theexperiments reported in this article were intended to assess this hypothesis.

METHODS

Three experiments were conducted to test the hypothesis that interruptions hurt diagnostic reasoning and increase time on task. In the first experiment (N = 42), internal medicine residents, while diagnosing vignettes of actual clinical cases were interrupted halfway with a task unrelated to medicine, solving word-spotting puzzles and anagrams. In the second experiment (N = 78), the interruptions were medically relevant ones. In the third experiment (N = 30), we put additional time pressure on the participants. In all these experiments, a control group diagnosed the cases without interruption. Dependent variables were diagnostic accuracy and amount of time spent on the vignettes.

RESULTS

In none of the experiments interruptions were demonstrated to influence diagnostic accuracy. In Experiment 1: Mean of interrupted group was 0.88 (SD = 0.37) versus non- interrupted group 0.91 (SD = 0.32). In Experiment 2: Mean of interrupted group was 0.95 (SD = 0.32) versus non-interrupted group 0.94 (SD = 0.38). In Experiment 3: Mean of interrupted group was 0.42 (SD = 0.12) versus non-interrupted group 0.37 (SD = 0.08). Although interrupted residents in all experiments needed more time to complete the diagnostic task, only in Experiment 2, this effect was statistically significant.

CONCLUSIONS

These three experiments, taken together, failed to demonstrate negative effects of interruptions on diagnostic reasoning. Perhaps physicians who are interrupted may still have sufficient cognitive resources available to recover from it most of the time.

Introducing free response short answer questions in anatomy spot tests: experiment study

PURPOSE

A spot test is commonly used to assess practical knowledge through a series of specific questions related to the marked anatomical structures on cadavers. However, the continuous reviewing and developing of the medical curricula demands the need to improve the assessment method of the practical examination of anatomical knowledge. Therefore, the aim of the study was to examine the effectiveness of a free response short-answer questions (FRSAQs) test and traditional questions on medical students' performance.

METHODS

This is an experimental study using a Randomized Posttest-Only Control Group Design to compare the mean of students' performance in addition to their perceptions about the two versions of the spot tests. Two hundred and ninety preclinical-year medical students were invited to participate in this study.

RESULTS

Only 109 (38%) students participated in this study. The data analysis showed a significant improvement in students' performance in the FRSAQs test (5.3 ± 2.7) than the traditional spot test (4.7 ± 2.6), (P = 0.04). The majority of the students (70%) preferred the FRSAQs spot test, citing that it is good test to assess practical knowledge. The psychometric analysis revealed that the FRSAQs produced more ideal stations (60%) when compared to the traditional spot test (10%).

CONCLUSION

The current study found that the FRSAQs spot test had a significant impact on students' performance, and it was considered an ideal, flexible, and stress-free assessment method when compared to the traditional spot test. Implementation of the strategy in teaching and in assessment is recommended.

Do poor patients suffer from inaccurate diagnoses more than well-to-do patients? A randomized control trial

BACKGROUND

Poor patients have greater morbidity and die up to 10 years earlier than patients who have higher socio-economic status. These findings are often attributed to differences in life-style between groups. The present study aimed at investigating the extent to which physicians contribute to the effect by providing relative poorer care, resulting in relative neglect in terms of time spent with a poor patient and more inaccurate diagnoses.

METHODS

A randomised experiment with 45 internal medicine residents. Doctors diagnosed 12 written clinical vignettes that were exactly the same except for the description of the patients' socio-economic status. Each participant diagnosed four of the vignettes in a poor-patient version, four in a rich-patient version, and four in a version that did not contain socio-economic markers, in a balanced within-subjects incomplete block design. Main measurements were: diagnostic accuracy scores and time spent on diagnosis.

RESULTS

Mean diagnostic accuracy scores (range 0-1) did not significantly differ among the conditions of the experiment (for poor patients: 0.48; for rich patients: 0.52; for patients without socio-economic markers: 0.54; p > 0.05). While confronted with patients not presenting with socio-economic background information, the participants spent significantly less time-to-diagnosis ((for poor patients: 168 s; for rich patients: 176 s; for patients without socio-economic markers: 151 s; p < 0.01), however due to the fact that the former vignettes were shorter.

CONCLUSION

There is no reason to believe that physicians are prejudiced against poor patients and therefore treat them differently from rich patients or patients without discernible socio-economic background.

Medical professionalism frameworks across non-Western cultures: A narrative overview

BACKGROUND

Medical professionalism is context-specific, but most literature on professionalism stems from Western countries. This study is about benchmarking of different frameworks on professionalism and interpreting the commonalities and discrepancies of understanding professionalism across different cultures. We need to study the cultural underpinning of medical professionalism to graduate future "global" practitioners who are culturally sensitive enough to recognize differences (and also similarities) of expectations of patients in various contexts.

AIM

This study aims at describing culture specific elements of three identified non-Western frameworks of professionalism, as well as their commonalities and differences.

METHOD

A narrative overview was carried out of studies that address professionalism in non-Western cultures in the period 2002-2014.

RESULTS

Out of 143 articles on medical professionalism, only four studies provided three structured professionalism frameworks in non-Western contexts. Medical professionalism attributes in non-Western cultures were influenced by cultural values. Out of the 24 identified attributes of professionalism, 3 attributes were shared by the three cultures. Twelve attributes were shared by at least two cultures, and the rest of the attributes were unique to each culture.

CONCLUSIONS

The three frameworks provided culture-specific elements in a unique conceptual framework of medical professionalism according to the region they originated from. There is no single framework on professionalism that can be globally acknowledged. A culture-oriented concept of professionalism is necessary to understand what the profession is dedicated to and to incorporate the concept into the medical students' and physicians' professional identity formation.

Does faculty motivation effect students achievement: results from five curriculum blocks of two undergraduate student cohorts at King Saud bin Abdulaziz University of Health Sciences (KSAU-HS)

Objective:

The purpose of the study was to assess the relationship between students’ perception of course/block coordinators performance and attributes with students’ assessment scores in respective courses.

Methods:

This retrospective data based study was conducted at the College of Medicine, King Saud bin Abdulaziz University of Health Sciences (KSAU-HS). It was started in March 2013 and completed in June 2013 after the graduation of the fourth cohort. Exam score of 3^rd and 4^th cohort of students from the courses taught in the last two years of medical school were correlated with faculty and block evaluation done by the students. Scores from mid-block MCQs, portfolio scores, OSCEs and end-of-block MCQs were obtained.

Results:

The Mean scores of all the assessments for all five blocks were not significantly different for both batches. There was significant difference between block coordinators for students’ score on portfolio, midterm exam and the final written exam. The students’ Score in OSCE had significantly strong correlation with quality of station monitors, coverage of content and flow between stations. Student’s perception of the commitment and motivation of the coordinator was strongly correlated with block organization, availability of clinical cases, performance of block coordinator, cooperation with students, and organization of clinical activities.

Conclusions:

Block coordinator’s motivation and commitment affects quality of block organization and student`s success. Faculty training programs should include block management competencies and components identified through self-determination theory for improving the intrinsic motivation for students success.

Constructing a question bank based on script concordance approach as a novel assessment methodology in surgical education

BACKGROUND

Script Concordance Test (SCT) is a new assessment tool that reliably assesses clinical reasoning skills. Previous descriptions of developing SCT-question banks were merely subjective. This study addresses two gaps in the literature: 1) conducting the first phase of a multistep validation process of SCT in Plastic Surgery, and 2) providing an objective methodology to construct a question bank based on SCT.

METHODS

After developing a test blueprint, 52 test items were written. Five validation questions were developed and a validation survey was established online. Seven reviewers were asked to answer this survey. They were recruited from two countries, Saudi Arabia and Canada, to improve the test's external validity. Their ratings were transformed into percentages. Analysis was performed to compare reviewers' ratings by looking at correlations, ranges, means, medians, and overall scores.

RESULTS

Scores of reviewers' ratings were between 76% and 95% (mean 86% ± 5). We found poor correlations between reviewers (Pearson's: +0.38 to -0.22). Ratings of individual validation questions ranged between 0 and 4 (on a scale 1-5). Means and medians of these ranges were computed for each test item (mean: 0.8 to 2.4; median: 1 to 3). A subset of test items comprising 27 items was generated based on a set of inclusion and exclusion criteria.

CONCLUSION

This study proposes an objective methodology for validation of SCT-question bank. Analysis of validation survey is done from all angles, i.e., reviewers, validation questions, and test items. Finally, a subset of test items is generated based on a set of criteria.

Determinants of effective clinical learning: a student and teacher perspective in Saudi Arabia

CONTEXT

Graduating clinically competent medical students is probably the principal objective of all medical curricula. Training for clinical competence is rather a complex process and to be effective requires involving all stakeholders, including students, in the processes of planning and implanting the curriculum. This study explores the perceptions of students of the College of Medicine at King Abdul-Aziz Bin Saud University for Health Sciences (KASU-HS), Riyadh, Saudi Arabia of the features of effective clinical rotations by inviting them to answer the question: "Which experiences or activities in your opinion have contributed to the development of your clinical competence? This college was established in 2004 and adopted a problem-based learning curriculum.

METHODS

This question was posed to 24 medical students divided into three focus groups. A fourth focus group interview was conducted with five teachers. Transcriptions of the tape-recorded focus group interviews were qualitatively analyzed using a framework analysis approach.

FINDINGS

Students identified five main themes of factors perceived to affect their clinical learning: (1) the provision of authentic clinical learning experiences, (2) good organization of the clinical sessions, (3) issues related to clinical cases, (4) good supervision and (5) students' own learning skills. These themes were further subdivided into 18 sub-themes. Teachers identified three principal themes: (1) organizational issues, (2) appropriate supervision and (3) providing authentic experiences.

CONCLUSION

Consideration of these themes in the process of planning and development of medical curricula could contribute to medical students' effective clinical learning and skills competency.

Stress and coping strategies among Arab medical students: towards a research agenda

BACKGROUND

Research conducted in the past ten years in the area of stress and coping among Arab medical students has identified some important issues, but other significant aspects have not yet been explored.

OBJECTIVES

To provide a systematic review of studies reporting on stress, anxiety and coping among Arab medical students and to identify implications for future research.

METHODS

PubMed was searched to identify peer-reviewed English-language studies published between January 1998 and October 2009 reporting on stress and coping among undergraduate Arab medical students. Search strategy used combinations of the terms: Arab medical student, stress, PBL, psychological distress, depression, anxiety and coping strategies. Demographic information on respondents, instruments used, prevalence data and statistically significant associations were abstracted.

RESULTS

The search identified 8 articles that met the specified inclusion criteria. Within the limited range of Arab medical students studied, studies suggest these students have a high prevalence of perceived stress, depression and anxiety, with levels of perceived psychological stress as high as those reported in the international literature for medical students of other regions of the world. Limited data were available regarding coping strategies, the impact of stress on academic performance and attrition among Arab students. No data were available regarding the impact of problem-based learning on stress and coping.

CONCLUSIONS

The existing literature confirms that stress, depression and anxiety are common among Arab medical students, as for students elsewhere. Little is known about the contribution of different curricula approaches to perceived stress and what coping strategies institutions and students apply to help alleviate stress. Large, prospective, multicentre, multi-method studies are needed to identify personal and curricula features that influence stress, depression, anxiety and coping strategies among Arab students.

Students' perceptions towards a family medicine attachment experience

OBJECTIVE

To explore the students' perceptions about their experience in a family medicine (FM) preceptorship in order to provide a sound basis for offering guidance to family medicine undergraduate education.

METHODS

During one full academic year at King Saud University, College of Medicine, Riyadh, Saudi Arabia, a self administered questionnaire was distributed to all students (n = 177) at the end of each 6 weeks family practice attachment course. Students were asked to rate their attachment by responding to a five-points Likert type scale questionnaire and other Yes/No questions reflecting different important points in teaching and training.

RESULTS

The teaching quality and the ability of the General Practitioners (GPs) preceptors to relate to students are rated very highly. Despite that, the majority of students (59.3%) feel their aims were not met during the attachment. Students indicate that there should be more teaching of practical procedure skills, more time allocated for discussion and a greater student involvement in the consultation.

CONCLUSION

There is much to be retained in FM preceptorships that involves the caring and communication aspects of learning patient care. The study showed that practical procedure skills are desirable features of a preceptorship programme and that an emphasis on doing vs. observing is preferred by students. Some conditions designed to improve preceptorships are outlined and basic practicalities of adding a preceptorship to a practice are considered.

Factors influencing patient choice of hospitals in Riyadh, Saudi Arabia

This study examined factors considered important in choosing a hospital. The sample consisted of 303 respondents selected from five randomly selected primary health care centres. The percentages of males, highly educated, high-income level, elder and private sector employees was higher in those choosing private sector hospitals, while marital status did not relate to type of hospital. The principal component analysis identified six factors accounting for 64% of the total variance. The most important component was 'medical services' accounting for 28% of the total variance. Stepwise discriminant analysis revealed that the main factors associated with choosing a hospital were medical services, accessibility, age, sex and education. Little importance was given to income and occupation. Future recommendations outline the need for consumers' perceptions, attitudes, suggestions and concerns to be taken into consideration when marketing the services to be provided.

Psychiatric co-morbidity in primary care and hospital referrals, Saudi Arabia

Psychiatric and physical morbidities among patients referred from primary health care (PHC) centres and general hospitals (GH) in Al-Qassim region were compared. Thus, 540 psychiatric referrals (GH = 138; PHC = 402) were selected randomly. Fifteen GH patients but no PHC patients were referred for admission. Psychiatrists made more diagnoses of dementia, affective and anxiety disorders, mixed anxiety-depression and somatoform disorders than clinicians and general practitioners (GPs). Clinicians made significantly more diagnoses of acute psychoses and somatoform disorders than GPs. Physical morbidity was noted in 38.4% and 17.2% of GH and PHC referrals respectively.

Physician-Nurse communication. Perceptions of Physicians in Riyadh

OBJECTIVE

The need for communication between nurse and physician in clinical practice is undisputed. The objectives of this study were to describe doctors' perceptions of their communication with nurses, as related to the openness of the communication and the accuracy of the information communicated and to examine if specific sociodemographic characteristics concerning physicians were associated with perception of communication.

METHODS

The sample consisted of 200 physicians selected randomly from 6 randomly selected hospitals representing both general and private. A modified Shortell's Intensive Care Unit physician-nurse communication subscale was used to measure the physician's perceptions of the degree to which openness and accuracy described their communication with nurses. Data was collected via a self-administered pilot questionnaire, which also included sociodemographic characteristics.

RESULTS

The overall mean score for openness was 2.61 and 3.19 for accuracy out of a maximum score of 5. For openness the highest mean score was obtained for "listening to physician (4.31)" and the lowest mean score was obtained for "hospital environment (1.84)". For accuracy, the highest mean score was obtained for "use of medical language (4.37)" and the lowest mean score was for "feedback (1.84)". The results showed a significant difference for experience, age and gender for both types of hospitals. For specialization, title and nationality no significant difference was observed for both types of hospitals for openness and accuracy. Multivariate regression analysis showed that gender, age and experience were the predictor variables for openness and accuracy. With more experienced, older aged females, having the highest mean score.

CONCLUSION

Communication between physician and nurses needs not remain only a researchable issue; its viability and vitality are crucial to the changing health care scene. Thus, the development of health delivery models that will enable effective multidisciplinary communication, cooperation and wiser use of limited resources in health care is essential.

Satisfaction and correlates of patients' satisfaction with physicians' services in primary health care centers

OBJECTIVE

To estimate quantitatively consumers' satisfaction and correlates of satisfaction with physicians' services provided by Ministry of Health Primary Health Care Centers in attending consumers.

METHODS

Consumers (n = 540) attending the selected Primary Health Care Centers in Riyadh were asked about their satisfaction with physician's services. Eight Primary Health Care Centers were randomly selected according to the geographical location, two from each geographical zone. Seventy-five subjects were selected systematically where every tenth Saudi aged 15 years and above who visited the selected Primary Health Care Centers during the study period was chosen. Data was collected via a self administered pilot tested, internally consistent patient satisfaction questionnaire which included socio-demographic characteristics as well as the overall and differential satisfaction with the different aspects of physicians' services in the selected Primary Health Care Centers rated in a scale of 1 5 points, the higher the score the higher the satisfaction.

RESULTS

The results revealed that males constituted 60%, and 58% of all patients were married, more than 60% were employees and more than 70% have a monthly income of less than 6000 Saudi Riyals. Almost 95% have an open file in the Primary Health Care Center and 39% think that the distance to the Primary Health Care Center is far or very far. The summary satisfaction score was 3.77 points and the mean satisfaction with the services provided by physicians was 2.56 points out of a maximum of 5 points The highest satisfaction was for discussing psychological aspects of patients' problems (2.96 points) and the lowest was for attentive listening to patients' complaints (2.22 points). Physicians' communication skills were more satisfactory to patients than their professional skills and satisfying patients' wishes scored the lowest satisfaction- Unskilled laborers, literate patients and patients with higher income showed significantly higher mean satisfaction while students, illiterates, those aged less than 50 years and patients with income less than 6000 Riyals per months scored the lowest satisfaction. The longer the distance travelled the lower the satisfaction scores but having a file or not was not related to satisfaction.

CONCLUSION

Some physicians' service items need corrective intervention and students and young patients appear to need more attention.

A taxonomy of community-based medical education

The authors propose a classification of community-based education (CBE) as it is implemented all over the world. To create this taxonomy, they used reports in the literature of 31 active programs in many locations. A CBE program is an instructional program carried out in a community context, outside the academic hospital. The authors distinguish between programs that are developed primarily to provide services to an underserved community; programs that have a research focus; and programs that have as their primary goal the (clinical) training of students. These three major types can be subdivided in six minor types, among them community development programs, health intervention programs, and simple community-exposure programs. The ultimate goal of creating the taxonomy is to contribute to the development of a theory of CBE and provide a more systematic way to study CBE. In addition, the proposed taxonomy clearly demonstrates the various ways in which medical schools, their staffs, and their students can become involved with the communities served. CBE is not a unitary concept but a set of attempts to contribute to the quality of life in a particular community and, at the same time, create conditions for students to acquire hands-on understanding of the nature of the problems to be faced in future professional practice, and to develop relevant skills. The taxonomy also enables those involved in the development of CBE programs in their medical schools to see alternative approaches, which will help them choose the approaches that fit their particular educational goals. Last, it demonstrates the intricacies involved in the implementation of CBE, in particular the complexity of building a learning environment that is productive for students and, at the same time, responsive to community needs.

Testing a causal model of community-based education in the Sudan

PURPOSE

To develop and test a model of community-based education.

METHOD

In 1995, after developing a hypothesized causal model for community-based education, the authors collected data for 106 students at the University of Gezira, the Sudan, who had participated over three summers in an interdisciplinary field training research and rural development course. The students rated each other on leadership, interaction with the community, subject-matter contributions, and effort. Teaching staff assessed the readiness of the community to collaborate. The students' achievement was measured by short essays measuring knowledge, supervisors' assessments of the students' performances in the community, the community's observations of the students' activities, the community's satisfaction, and a group-produced report evaluated by faculty. The effect of the students' activities on the community was measured by comparing baseline and post-intervention community health data. The students also indicated their levels of interest in the community's problems. The authors analyzed the resulting covariances using structural-equations modeling.

RESULTS

After minor adaptations, the model fitted the data reasonably well. The path coefficients were quite high, particularly among the peer ratings. Leadership had a potent effect on the outcome measures, as did, to a lesser extent, the readiness of the community to collaborate with the students.

CONCLUSION

This study was the first reported attempt to test a model of community-based education. Although the fit of the data to the model in the study was reasonable, further study is needed to unearth additional important elements of community-based education. This article also discusses methodologic shortcomings of the present study, such as a possible "halo effect" in the peer ratings and the retrospective nature of many of the measurements.

Student assessment in community settings: a comprehensive approach

Student assessment in community settings presents problems for medical teachers, e.g., difficulties in assessing the contribution of individual members to group work, and lack of test standardization due to varying field conditions. The Faculty of Medicine, University of Gezira, Sudan is a community-oriented, community-based medical school which has adopted a comprehensive approach to student assessment in community settings using various methods, including peer assessment, a supervisory checklist, community feedback, reports from students, short essay questions (SEQs) and multiple choice questions (MCQs). Each method focuses on a specific aspect of the objectives of the community-based programme and is weighted in the final grade according to the extent to which objectives were covered. This assessment programme contrasts with the conventional teacher-centred approach, and is continuously monitored and improved using a variety of sources of information. A total of 105 students participated in a study designed to measure the reliability and validity of this approach. The reliability of the methods was tested by computing the alpha coefficient and was found to range between 0.77 and 0.92. This was considered acceptable. The validity of the instruments was examined using confirmatory factor analysis, and their content validity was reviewed. The results show that the comprehensive approach used is fairly valid. It is suggested that the University's approach is successful in solving some of the problems of student assessment in community settings.

An outbreak of dracunculiasis in central Sudan

This paper describes an outbreak of dracunculiasis in Mazmum, a town in central Sudan. The study included collection of clinical and epidemiological data from 319 patients treated in hospital, a review of the hospital records, a house survey covering a sample of 757 subjects, a school survey covering 1390 schoolchildren, and examination of water sources. The overall incidence of the disease was 23.4%, with most cases appearing in the agricultural season (July-October). Incidence was highest in young females but most severe disability occurred in male patients aged > or = 20 years, of whom more than 60% were unable to work for more than 4 weeks. The disease is transmitted in shallow natural pools, artificial ponds and trenches in rocky hills that hold rain water. All these sources were found to be infested with Cyclops. The outbreak is attributed to deterioration in the structure and management of the water sources, together with a massive population influx from other endemic areas. These observations underscore the importance of co-ordinating efforts to eradicate the disease from African countries.