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Biomedical subjects

D I Newble

Publications and source records attributed to D I Newble.

At least 37 records · Page 2Linked to original sources
PubMed1986

The approaches to learning of students in a traditional and in an innovative problem-based medical school.

The way in which students approach their learning is dependent on a variety of factors including the characteristics of the departments and teaching to which they are exposed. These factors appear to influence whether the students adopt a surface, deep or strategic approach. In order to explore further the relationship between educational context and approach to learning, a comparison was made between students attending a traditional medical school and those attending a problem-based medical school. The results showed marked differences, with the problem-based school being higher on deep approach and lower on surface approach than the traditional school. This study provides one of the first pieces of evidence of a difference between students in the two types of medical school which can be directly attributed to the educational environment. Students in the problem-based school appear to have an approach to learning which more closely approximates the aims of most medical schools. The results provide support for the philosophies and strategies of the problem-based schools.

Australia↗
PubMed1985

The learning style of medical students.

Recent research indicates that students' learning styles and approaches to study may have a significant bearing on their academic success. A study was undertaken on first-, third- and final-year medical students to analyse their preferred learning styles and approaches to study, using the Lancaster Approaches to Learning Inventory. The results showed that students entering the medical school had preferences which were more similar to science students' than arts students'. The medical students had high scores on reproducing orientation (surface approach) in all years tested. The first-year students had low scores on meaning orientation (deep approach) but the scores from students in later years showed a progressive rise. The implications of these results with regard to selection, teaching and assessment are explored. However, this preliminary study does not allow us to differentiate between the effect of student preference and that of the context and the environment in which they study.

Australia↗
PubMed1983

The effect of assessments and examinations on the learning of medical students.

This paper describes a situation where an alteration in the final-year assessment scheme led to changes in student learning activities which were the exact opposite of those intended. Students were seen to be spending a disproportionate amount of time studying the theoretical components of the course relative to the practical and clinical aspects. The paramount importance of the assessments and examinations in influencing student learning behaviour led the departments concerned to develop a new clinical examination which more clearly reflected the objectives of the course. A questionnaire survey was undertaken to determine how the different sections of the final assessment affected the students' approach to studying. The questionnaire was administered to graduates during their intern year for the 3 years following the introduction of the new clinical examination. Results were also obtained for the year preceding the change. The survey showed that the students developed a high regard for the new examination and its validity as a test of clinical competence. The students found that an increase in ward-based learning activities was essential for success in the final examinations. The new clinical examination has thus influenced students' learning and successfully restored the balance of their learning activities between the clinical and theoretical components of the course.

Australia↗
PubMed1982

Patient management problems. Issues of validity.

Patient management problems (PMP) are being used in medical examinations with increasing frequency despite evidence which throws doubt on their validity as measures of clinical competence. This study investigated the construct validity of a PMP constructed in both written and interview formats. Each test was administered to groups of students of different seniorities and to two groups of doctors, interns and post-interns. The pattern of scores for the different groups was not that expected of a valid test of competence. The most competent groups (the post-interns) generally scored less well on the calculated indices than the senior students and interns. These findings were similar for both formats of the test so cueing was not thought to be the major factor. It appears that the scoring system is at fault. A comparison of performance on the written and interview (uncued) formats showed that many more options were chosen by all groups tested on the written PMP. It was concluded that written PMPs cannot yet be regarded as a valid simulation of clinical performance. Although content validity is high this does not appear to be so for construct validity or concurrent validity.

Australia↗
PubMed1982

An audit of investigational services within general medical units.

Over a period of a year data was collected on the utilisation of investigational services by three general medical units. The pattern of practice was found to be very similar between the units. The average calculated daily test cost per patient ranged from +12-23 and the average dialy number of tests per patient was less than two. The services contributing most to costs were the relatively cheap but frequently-performed laboratory and radiological investigations. The implications of these findings in relation to hospital costs and to the education of medical staff is discussed.

Australia↗
PubMed1981

The validity and reliability of a new examination of the clinical competence of medical students.

In a previous study we described a problem-based criterion-referenced test of the clinical competence of medical students which was felt to offer advantages over the traditional final-year examination. This paper reports the validity and reliability studies on which it is possible to judge the value of this new test when compared to the traditional approach. The results demonstrate a high level of content validity and provide evidence of the construct validity of the test. Efforts to obtain measures of concurrent and predictive validity were thwarted by a failure to attain reliable assessments of ward performance from resident and consultant staff. Satisfactory levels of internal consistency were established for the whole test. Marker reliability was satisfactory in all sections of the test except for those requiring examiners to rate practical clinical skills. This was so despite the use of simulated patients, behavioural check-lists and rater training. Possible solutions to this problem are discussed. It is concluded that this new approach overcomes many of the measurement problems inherent in the traditional final examination. It has been shown to be feasible to construct and administer in the medical school setting without the need for the allocation of additional resources.

Australia↗
PubMed1980

The selection and training of examiners for clinical examinations.

The inconsistency of the marking in clinical examinations is a well documented problem. This project identified some of the factors responsible for this inconsistency. A standardized rating situation was devised. Five students were videotaped as they performed part of a physical examination on simulated patients. Eighteen experienced medical and surgical examiners rated their performances using an objective checklist type of rating form. No differences were evident between physicians and surgeons. The group of examiners was divided into three subgroups, one receiving no training, one limited training and one more extensive training. Examiners re-rated the same students 2 months after the first rating. Inter-rater reliability was satisfactory for the first ratings and training produced no significant improvement. A substantial improvement was achieved by identifying the most inconsistent raters and removing them from the analysis. Training was shown to be unnecessary for consistent examiners and ineffective for examiners who were less consistent. On the basis of these results, only consistent examiners were selected to take part in the interactive component of the objective structured final year examinations. The ratings in these examinations achieved high levels of inter-rater reliability. It was concluded that the combination of an objective check-list rating form, a controlled test situation and the selection of inherently consistent examiners could solve the problem of inconsistent marking in clinical examinations.

Educational Measurement↗
PubMed1979

A comparison of multiple-choice tests and free-response tests in examinations of clinical competence.

This paper reports a study which compared the performance of different groups of students and doctors on identical and equivalent tests set in an objective-type format and in a free-response format. The tests were designed to ensure that the content was relevant to clinical practice at the hospital intern level. In all test situations candidates' scores were significantly higher in the objective tests than in the free-response tests. This difference was greater for the more junior and less competent students than for the more competent doctors. The cueing effect of the options was thought to be the main factor responsible for the difference in performance. The results of a questionnaire survey demonstrated that students were aware of the deficiencies in multiple-choice tests. A large majority of the students believed that the free-response tests gave a more accurate assessment of their clinical ability. It was found that in these tests, aimed at measuring aspects of clinical competence, multiple-choice questions appeared to overestimate the candidate's ability to an extent that made them less suitable than free-response questions for this purpose. It was also found that free-response tests, of the type used in this study, provide a suitable alternative to multiple-choice tests for use in the written section of clinical examinations. It was concluded that the written component of the final examination in the medical course should have a preponderance of free-response items over multiple-choice items.

Australia↗
PubMed1978

A problem-based criterion-referenced examination of clinical competence.

A model has been developed for a problem-based criterion-referenced test of clinical competence. The model, designed to increase the reliability and validity of traditional final year examinations for medical students, aims to provide a profile of student performance over a range of defined competence categories. The level of competence has been referenced to that expected of an intern. Both the content of the examination and the selection of test methods are based on patient problem blueprints which identify key areas that require testing. The content and test methods were incorporated, as appropriate, into either th;e written section or the practical section of the examination. The approach was found to be feasible and acceptable to staff and students.

Australia↗
PubMed1978

An evaluation of five years experience with a physicians workshop.

This paper reports five years experience with a new type of continuing education programme for practising physicians. The continued development and the organisation of the programme is described. A high proportion of the hospital's physicians have regularly attended and participated. Annual questionnaire surveys have shown a high degree of satisfaction with the the programme and the majority of physicians give it a high priority in their continuing educational activities. The features which appear to be responsible for the success of the programme include the variety of the format, the quality of the presentations, the active participation by all physicians and the fact that the activities are specifically aimed at the practising physician rather than physician trainees.

Attitude of Health Personnel↗
PubMed1976

The evaluation of clinical competence.

This review examined new approaches to the definition and evaluation of clinical competence. Competence may be defined in terms of the components of the process of clinical performance or in terms of the outcomes of clinical performance. No single test method is capable of providing a valid and reliable evaluation of all defined aspects of clinical competence. Both in this country and overseas, new test methods and examinations are being developed and the implications which they will have for Australian medical schools are discussed.

Australia↗
PubMed1975

Immune reactions in acute viral hepatitis.

Serial studies of PHA-induced lymphocyte transformation, serum autoantibodies, immunoglobulins and complement were performed in seventeen patients with hepatitis A and nine patients with hepatitis B. In both types of hepatitis PHA-induced transformation was markedly impaired during the 1st week after the onset of jaundice and there was less marked but prolonged impairment for a further period of 6-10 weeks. A group of eleven subjects with a previous history of hepatitis had values which were similar to those of healthy persons. Serum from patients with hepatitis A and hepatitis B contains an inhibitor of lymphocyte response to PHA. The inhibitor depresses the function of both patients' and normal lymphocytes and is only detectable during the acute phase of the illness. Washing lymphocytes free from autologous serum did not restore the PHA response to normal but the markedly impaired response present during the first 2 weeks of the illness was improved. A serum factor or factors may therefore be responsible for at least part of the impaired response of lymphocytes to PHA during the acute phase of hepatitis but does not appear to account for the more prolonged impairment of the PHA response. The protracted lymphocyte defect is possibly induced by hepatitis virus. The incidence of autoantibodies and the changes in immunoglobulin levels were similar to those reported by other workers.

Antibody Formation↗