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J A Colliver

Publications and source records attributed to J A Colliver.

At least 37 records · Page 2Linked to original sources
PubMed1996

Ventures in education: a pipeline to medical education for minority and economically disadvantaged students.

BACKGROUND: Ventures in Education is an independent, nonprofit educational organization established by the Josiah H. Macy, Jr. Foundation to improve the academic achievement of minority and economically disadvantaged students, particularly in science and mathematics. One specific objective has been to increase the number of students who enter schools of the health professions, in particular schools of medicine, which was the focus of this study. METHOD: A search was conducted of the Association of American Medical Colleges' (AAMC's) Student and Applicant Information Management System database, to determine whether any of the 981 graduates in the first five Venture classes (1985 to 1989) of the original five New York City high schools in the program had pursued medical education. RESULTS: The search located 160 of the 981 Ventures graduates, and, of those, 136 had taken the Medical College Admission Test (13.9%), 109 (11.1%) has applied to medical school, 75 (7.6%) had been accepted, and 72 (7.3%) had matriculated into medical school. All of these percentages were significantly higher than the corresponding percentages for the general population. CONCLUSION: The findings have important implications for the AAMC's Project 3000 by 2000, showing that a rigorous academic curriculum with resources for individualized attention can facilitate the entry of minority and economically disadvantage students into medical education, with at least 7.3% of the Ventures graduates entering medical school and nearly 70% of those applying subsequently being accepted.

Achievement↗
PubMed1996

Double-blind, placebo-controlled study of metrifonate, an acetylcholinesterase inhibitor, for Alzheimer disease.

Fifty patients with probable Alzheimer disease (AD) completed a 3-month double-blind study to compare metrifonate to placebo. We dosed metrifonate to achieve a 40-60% inhibition of red blood cell acetylcholinesterase activity. The Alzheimer Disease Assessment Scale cognitive subscale score (ADAS-C) served as the primary outcome measure. At the completion of 3 months of treatment, the metrifonate group ADAS-C score differed significantly from the placebo group score by 2.6 points (p < 0.01). A 0.75-point trend toward improvement occurred during treatment in the ADAS cognitive performance of the metrifonate group (p = 0.15), and a 1.10-point deterioration in cognitive performance was found in the placebo group (p < 0.02). On the Global Improvement Scale (GIS), the two groups differed significantly on their changes from baseline to treatment phase (p < 0.02). Significant deterioration occurred in GIS scores (p < 0.01) and in Mini Mental State Examination (MMSE) scores (p < 0.03) in the placebo-treated group. Adverse effects were uncommon and did not require adjustment of the dose of metrifonate or discontinuation of treatment. We achieved a mean of 52.3% decrease in red blood cell acetylcholinesterase activity. During up to 18 months of subsequent open metrifonate treatment of patients, we found a deterioration of 1.68 points per year in MMSE performance. These findings support further study of the effects of metrifonate on deterioration rate in AD.

Aged↗
PubMed1995

Comparing checklists and databases with physicians' ratings as measures of students' history and physical-examination skills.

PURPOSE: To compare two methods of rating students' performances on history and physical examination: (1) by using checklists completed by standardized patients (SPs) and databases completed by students, and (2) by using ratings of students by three physicians for each SP-student encounter. METHOD: Four cases were chosen for the study, and 30 students were examined per case. The students were all in their fourth year at the Southern Illinois University School of Medicine in the spring of 1991. Two of the cases had both checklists and databases, and the remaining two had databases only. Each SP-student encounter was videotaped and was viewed independently by three physicians unfamiliar with the contents of the checklists and databases. The physicians' pooled ratings were then compared with the checklist and database scores. Uncorrected and corrected correlations were obtained, with the generalizability coefficient used as the index of reliability. RESULTS: Interrater generalizability of physicians' ratings was very good, ranging from .65 to .93 for overall ratings. Generalizability of physicians' ratings pooled across the four cases was .85. Checklist scores tended to correlate higher with physicians' ratings than did database scores: across the cases, correlation coefficients between physicians' ratings and checklist scores and database scores were .65 and .39, respectively. CONCLUSION: The checklist scores correlated strongly with the physicians' ratings of history and physical-examination skills, providing some evidence of validity for their use. The checklist scores correlated much better with the physicians' ratings than did the database scores. Possible explanations for this finding are discussed.

Clinical Clerkship↗
PubMed1995

Effect of anonymous test grading on passing rates as related to gender and race.

BACKGROUND: Concerns about potential bias in the grading of medical students at the Southern Illinois University School of Medicine led to a major institutional policy change whereby students' identities were masked during the test-grading process. The present study assessed the effect of this anonymous test grading policy by comparing the performance of men and women students and of white and African American students prior to and after adoption of the policy change. METHOD: A test-passing rate was determined for each of 476 freshmen students in the comparison groups from the eight classes of 1988 through 1995. Mean test-passing rates for the four student cohorts prior to policy implementation (1988-1991) were compared with mean passing rates after the policy was implemented (1992-1995). RESULTS: The pre-post change in the mean test-passing rate of men was not significantly different from the pre-post change of women, and a nonsignificant effect was also found when the pre-post change in the mean test-passing rate of white students was compared with that of African American students. No significant pre-post change was found for white men, white women, African American men, or African American women. CONCLUSION: The results showed no effect of the anonymous test-grading policy, which suggests that there was no widespread gender or racial bias in the grading of freshman medical students before the change in institutional grading policy.

Black or African American↗
PubMed1993

A difference between front-loaded streptokinase and standard-dose recombinant tissue-type plasminogen activator in preserving left ventricular function after acute myocardial infarction (the Central Illinois Thrombolytic Therapy Study).

A blinded, randomized trial compared the effects of front-loaded streptokinase with those of the conventional dose of intravenous recombinant tissue-type plasminogen activator (rt-PA) on left ventricular (LV) function after acute myocardial infarction (AMI). Thrombolytic therapy was administered in the emergency departments of 30 community hospitals in central Illinois, and subsequent studies were performed at 1 tertiary referral center. Patients aged < or = 75 years with a first AMI who could be treated within 4 hours of the onset of chest pain were randomly assigned to receive either streptokinase (375,000 IU bolus, followed by 1,125,000 IU over 1 hour) or rt-PA (10 mg bolus, followed by 50 mg in the first hour, and 20 mg/hour for the next 2 hours). All patients were treated with aspirin (325 mg) and intravenous heparin. Patients were transferred for angiography within 24 hours. During the 30-month study, 253 patients were treated with intravenous thrombolytic therapy 2.4 +/- 1.0 hour after the onset of AMI. In patients with anterior wall AMI (n = 90), global LV ejection fraction measured by angiography within 24 hours was 45 +/- 12% with rt-PA, and 39 +/- 13% with streptokinase (p < 0.03). Convalescent radionuclide angiography documented a persistent beneficial effect of rt-PA on LV regional wall contractility, but not global ejection fraction. There were no differences between rt-PA and streptokinase in preserving global or regional LV function in patients with inferior wall AMI.

Aged↗
PubMed1993

Effects of examinee gender, standardized-patient gender, and their interaction on standardized patients' ratings of examinees' interpersonal and communication skills.

PURPOSE: To assess the effects of examinee gender, standardized-patient (SP) gender, and, in particular, their interaction on ratings made by SPs of examinees' interpersonal and communication skills in a performance-based examination of clinical competence. METHOD: The examination was administered to four classes of senior medical students (about 70 per class) at Southern Illinois University School of Medicine, 1988-1991. The skill dimensions tested were clarity of communication, thoroughness of explanation, professional manner, personal manner, and overall patient satisfaction. Split-plot analyses of variance were used. RESULTS: There was no interaction of examinee gender and SP gender for any of the five rating scales. There was no main effect of examinee gender for four of the five scales; however, for personal manner, women students were rated slightly higher than men students. There was a main effect of SP gender, but the effect was not consistent from rating scale to rating scale or from class to class. Nevertheless, differences in ratings given by men and women SPs should not be of psychometric concern, since the ratings of men and women examinees are necessarily affected alike. CONCLUSIONS: Except for the women examinee's higher performance in personal manner, the men and women examinees generally performed equally well with respect to interpersonal and communication skills, and they performed equally well regardless of the gender of the SP.

Analysis of Variance↗
PubMed1993

Clinical performance-based test sensitivity and specificity in predicting first-year residency performance.

To assess the use of a standardized-patient-based postclerkship examination (PCX) to predict students' performances in their first year of residency, the authors used data from 202 students of the classes of 1987, 1988, and 1990 at the Southern Illinois University School of Medicine. The PCX was found to be more sensitive than specific in that it identified more correctly those students who received high ratings in their first year of residency than those who received low ratings. Consequently, while the rate of false negatives was low across the three classes, the rate of false positives was relatively high. Analyses of the supervisors' written comments on residents' performances indicated that more than half of the false positives and false negatives resulted mostly from problems found with the supervisors' ratings, rather than from the inaccuracy of the PCX in predicting students' residency performances. The supervisors' ratings did not always match their written comments and did not always represent pure assessments of the residents' cognitive performances. Finally, because of the large number of missing residency performance ratings among the graduates who had performed unsatisfactorily on the PCX, it is expected that the sensitivity of the PCX may be overestimated and its specificity underestimated. Overall, the results suggest that the standardized-patient-based PCX is a useful indicator of students' readiness for and performance in residency.

Clinical Competence↗
PubMed1993

Station-length requirements for reliable performance-based examination scores.

PURPOSE: To directly compare the generalizability of medical students' performance scores under systematically varied station times in two surgery end-of-clerkship performance-based examinations. METHOD: The participants were 36 third-year students randomly assigned to the first two rotations of the core surgery clerkship during 1991-92 at Southern Illinois University School of Medicine. The students rotated through a 12-station examination that employed standardized patients (SPs). In the first rotation, the student took six five-minute stations and six ten-minute stations. In the second rotation, the time lengths were reversed for the same stations. The students' total scores were based on (1) subscores on checklists that were completed by the SPs and (2) subscores on the students' written responses to short questions about each station (these responses were provided at station couplets that were five minutes long, regardless of station length). Generalizability coefficients were computed from the pooled rotation results to provide reliabilities for scores from the two station lengths. RESULTS: Generalizability decreased in the ten-minute stations, mostly attributable to less variability among students' performances. The checklist subscores accounted for most of this variability, while couplet subscores remained stable between station lengths. CONCLUSION: The longer station length actually decreased the generalizability of the scores by decreasing the variability among students' performances; thus, allocating different times to stations can affect the score reliability, as well as impact on the overall testing time, of performance-based examinations.

Clinical Clerkship↗
PubMed1993

Effects of student gender and standardized-patient gender in a single case using a male and a female standardized patient.

BACKGROUND: In previous studies assessing the effects of student gender, standardized-patient (SP) gender, and their interaction on multiple-station examinations of clinical competence, SP gender was confounded with cases, that is, male SPs were used for some cases and female SPs for others. The authors conducted two studies to investigate the effects of gender on a single case by using a male SP and a female SP for the same case. METHOD: Both studies involved one SP case in a comprehensive clinical evaluation used to assess fourth-year students at the end of a required ambulatory care clerkship at Saint Louis University School of Medicine in 1990-91 and 1991-92. In Study 1, 45 students in four rotations saw the same male SP; 42 students in three other rotations saw the same female SP. In Study 2, 69 students in six rotations were randomly assigned either the male SP (28) or the female SP (41) within the same rotation. For each study, to determine the interaction of student gender and SP gender as well as their main effects, analyses of variance were performed on the students' history-taking and physical examination scores and communication skills ratings. RESULTS: Neither study showed a significant interaction of student gender and SP gender on history taking, physical examinations, or communication skills. CONCLUSION: The findings of both studies suggest that the interaction between student gender and SP gender, unconfounded by case content, had no effect on the students' scores and ratings.

Abdominal Pain↗
PubMed1993

Technical issues: test application. AAMC.

Eighteen questions are posed that the authors believe address the major technical issues involved in the application of standardized patients (SPs). Following each question, selected empirical evidence and commentary are provided in response to the question and as background for further consideration of the issues. The authors conclude that the evidence from this large and systematic knowledge base about SP examinations is encouraging and should be cause for optimism. Moreover, it is noted that far less is known about the measurement properties of conventional procedures for clinical assessment in medical school courses and clerkships. The collective evidence from this extensive SP research base suggests that medical educators should move ahead to realize the benefits of the high-fidelity standardized approach provided by standardized-patient examinations.

Clinical Clerkship↗
PubMed1992

Six years of comprehensive, clinical, performance-based assessment using standardized patients at the Southern Illinois University School of Medicine.

By the end of 1990-91, the Southern Illinois University School of Medicine had had six years of experience with comprehensive, performance-based examinations of senior medical students' levels of clinical competence; this report assesses the psychometric aspects of the six examinations given during that period. The examinations were aimed at determining the students' readiness for postgraduate training. Compared with other clinical performance-based assessments that use standardized patients (SPs), these examinations had two important and unique features: (1) the examinations assessed a comprehensive range of clinical skills and reasoning; and (2) they approximated the challenges of real clinical practice wherein a practitioner's skills need to be orchestrated and prioritized in order to meet the challenges of the case encountered. Each year, the performance-based assessment given was an intensive clinical examination requiring each student to work up 13 to 18 SP problems over a three-day period. To administer an examination to an entire class of students took three weeks. Because all students after the first year of administration (1986) were required to pass these examinations, the fairness of test design and scoring and the setting of performance standards for the examinations became important issues for the faculty. The results, accumulated over six years and based on a total of 6,804 student-patient encounters involving 405 students, indicate that this kind of clinical performance-based examination can discriminate a wide range of students' clinical performances. The results provide evidence for the examinations' test security, content validity, construct validity, and reliability.

Clinical Clerkship↗
PubMed1992

Screening test length for sequential testing with a standardized-patient examination: a receiver operating characteristic (ROC) analysis.

The feasibility of using sequential testing (i.e., using a screening test) to reduce the length and expense of a performance-based examination with standardized-patient cases was demonstrated previously. In the present study, quantitative criteria rather than practical considerations were used to determine optimal values for the length of the screening test (i.e., number of cases) and the location of the screening pass-fail cutoff (i.e., its relation to the mean of the pass levels for the different cases). Data were derived from five classes of senior students at the Southern Illinois University School of Medicine, 1987-1991. Specifically, receiver operating characteristic (ROC) curves were plotted for screening tests of varying lengths, with the points on each ROC curve corresponding to different pass-fail cutoffs on the screening test. The results showed that good accuracy can be attained with a screening test that is only one-third the length of the full examination and that the cutoff for this screen should be set slightly above the mean of the case pass levels to maximize sensitivity and specificity. The authors conclude that their study demonstrates the value of an ROC analysis in evaluating the psychometric properties of a screening test in sequential testing.

Clinical Clerkship↗