MUSA - Alberta Pharmacy Students' Association

Recommendations

Info

COMMENTARY OSCE: The subjective experience of an objective exam Alim Nagji, BHSc Medical Student (2012), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada Correspondence to Alim Nagji, Email: anagji@ualberta.ca Abstract The Objective Structured Clinical Examination (OSCE) is the primary modality for testing clinical skills throughout medical school and in residency training. This article explores the difficulties of the exam via the subjective perspective of a student in the system, commenting on reticent standardized patients, the lack of consensus on what makes an ideal medical student and the absence of feedback. As the exam celebrates nearly four decades in use, it is important that we continue to evaluate its usefulness and brainstorm innovative approaches to advancing the state of clinical examinations. The Objective Structure Clinical Examination (OSCE) has rapidly become the leading clinical examination in North American Medical Schools. The unassailable champion of repetitive and reproducible evaluation, it has become the envy of all other tests. While multiple choice still holds a prominent position in most medical curricula, that is usually for the convenience of administering the test and the sheer volume of information one can sift through. As a learner, one has had ample time to exploit the system, mastering the nuances of the “all of the following EXCEPT” and “which answer is the BEST” questions. In reality, we have been asked this type of question since kindergarten and the PBS specials we grew up on sang “one of these things is not like the other one.” 1 The OSCE is succinctly explained in the abstract of a 1975 BMJ article: “the examination is more objective and a marking strategy can be decided in advance.” 2 The veracity of the latter half of this requirement is evidenced by the rubric style approach of many modern OSCEs. However, the first part is where the interesting dilemma lies. Is the examination more objective? From the subjective experience of students, it would hardly seem so. The variability lies in the innate qualities of both the “standardized patient” and the examiner. Having worked as a standardized patient, the instructions one often receives is to be as guarded as possible about information, refraining from volunteering details unless specifically probed. This is in direct contrast to the guidance offered in basic history taking skills, where students are counselled to allow the patient to convey the narrative of their illness uninterrupted. For those that have participated in OSCEs, it is easy to recall those actors from whom information had to be stolen as if it were precious gems. From many a station I have walked out and, in conversation with my peers in different tracks, realized that another “standardized” patient had been much more forthcoming with a pivotal piece of the diagnostic puzzle. In Rowntree’s 17 proposals for better assessment, he notes that “there is an assumption rampant in talk of academic standards, that all qualified assessors feel, understand and judge in much the same way when confronted with the work of a particular student. It is presumed that they would notice and value the same skills and qualities and would broadly agree in their assessments. Abundant evidence attests to the falsity of such assumptions.” 3 In the same 2 way, examiners vary widely in their preferences of what they believe makes the ideal learner. One need only glance at the complicated medical admission system or the behemoth that is the Canadian Resident Matching Service (CaRMS) to realize that we cannot agree on the perfect model student, yet we continue to cling to antiquated standards so as to maintain a united front. Despite the broad accusations suggesting poor inter-rater reliability across a variety of domains, 4 OSCE examinations remain a mainstay of evaluation despite their artificial construction and potentially variable environment. In the same seminal article, the authors proclaim that the “examination results in improved feed-back to students and staff.” 2 This may hold true for the teaching OSCEs, where 2 minutes of personalized commentary follows each station, but for the majority of exams in medicine, the results are protected and not released. So while occasionally one may receive a grade or score sheet, one is left waiting for the commentary that can enhance clinical skills or refine an approach. The majority of instructors emphasize the need to train physicians, not test takers, yet the very nature of receiving a pass or a fail undermines the learning process. Research has shown that overall, detailed, descriptive feedback was found to be most effective when given alone, unaccompanied by grades or praise, the direct opposite of what students usually receive. 5 The OSCE has significant advantages over multiple choice questions, providing a rich opportunity for students to simulate patient encounters and maintain some degree of standardization. However, it’s limitations and shortcomings should be discussed, rather than disputed. The modern OSCE, nearly 40 years after its rise to prominence, seems stagnant in the face of the rapid change in the medical community. Perhaps as we enter a new decade of medical education we can critique our instruments, as well as our students, and develop innovative models to evaluate competence in clinical skills. 1. Cooney, J.G. (creator). Seasame Street [Television Series]. New York: PBS 1969. 2. Harden, R. McG. Stevenson, M., Downie, W.W. & Wilson, G.M. Assessment of clinical competence using objective structured examinations. British Medical Journal 1975;I: 447. 3. Rowntree, D. Assessing students: how shall we know them? London: Kogan Page 1977. As cited in: Harden, R., Gleeson, F.A. Assessment of clinical competence using an objective structured clinical examination (OSCE). Medical Education 1979;13(1):39-54. 4. Thistlethwaite, JE. Developing an OSCE station to assess the ability of medical students to share information and decisions with patients: issues relating to interrater reliability and the use of simulated patients. Educ Health (Abingdon) 2002;15(2):170-9. 5. Lipnevich, A.A., Smith, J.K. Response to assessment feedback: The effects of grades, praise and sources of information. Retrieved from ProQuest Digital Dissertations 2008; 3319438. University of Alberta Health Sciences Journal • April 2012 • Volume 7 • Issue 1
University of Alberta Summer Students’ Research Day In 2011, over 200 undergraduate students participated in the Faculty of Medicine & Dentistry Summer Student Research Program. On October 15, 175 students presented posters at the 44th Annual Summer Students’ Research Day. Listed below are the 14 finalists from the poster competition. We congratulate the finalists and all participants. From these 14 finalists, two students were selected to represent the University of Alberta at the annual National Students’ Research Forum in Galveston, Texas. Their abstracts are presented below. Uncovering the role of topoisomerase II-beta binding protein 1 in dna replication stress response Mark Assmus, Charles Leung, Mark Glover DNA replication stress can lead to genomic instability which has been shown to be one of the primary hallmarks of cancer. TopBP1 is a crucial mediator protein found within the replication stress response in mammalian cells. TopBP1 activates Ataxia telangiectasia mutated related (ATR) kinase which phosphorylates many of the downstream substrates to initiate this response. The replication stress response involves specific interactions between the nine BRCA1 C terminus (BRCT) domains of TopBP1 and various proteins. More specifically, TopBP1 has been shown to provide an essential role in interacting with both ATR-interacting protein (ATRIP), Rad9-Rad1-Hus1 (9-1-1) complex as well as Mediator of DNA damage checkpoint protein 1 (MDC1) which are all essential components of the response pathway. The crystal structure of TopBP1 BRCT 4/5 in complex with MDC1 was previously solved in our lab. The structure shows a unique mode of TopBP1 binding to MDC1 that involves the dimerization of two BRCT 4/5 molecules. In an effort to further examine this interaction, I used a fluorescence polarization (FP) binding assay involving an MDC1 FITC labelled di-phospho-peptide. I was able to express and purify GST fusion proteins of TopBP1 BRCT 4/5 and TopBP1 BRCT 5, as well as TopBP1 BRCT 5 alone, which were used for further FP studies. The results of the FP assays indicated that it is the BRCT 5 binding pocket which is primarily responsible for the interaction with MDC1 and that the dimerization induced by GST allows for tighter binding. Additionally, mutant constructs of the putative BRCT 5 binding pocket were designed, successfully over-expressed and purified. The FP assays showed decreases in binding affinity associated with mutation of key conserved residues in the binding pocket. FP was also used to confirm that the phosphorylation of the MDC1 peptide is essential for TopBP1 BRCT 4/5 recognition. Taken together, these FP results further support the unique dimerization-based binding mechanism suggested by the crystal structure. PaX3 expression in melanoma Zachary Tan and D. Alan Underhill The transcription factor PAX3 is critical for development of neural crest lineages including melanocytes. Prior to birth, PAX3 is required for the proliferation of melanocyte precursors and it is thought to maintain an ‘undifferentiated plastic state’ in epidermal melanocytes after birth, as well in melanocyte stem cells. In addition, PAX3 is expressed throughout melanoma progression, from nevi to metastatic disease. Nevertheless, little is known about how PAX3 carries out these diverse roles. PAX3 is reported to be phosphorylated by Glycogen Synthase Kinase 3ß (GSK3ß). In the present study, the potential role of this kinase in modulating PAX3 activity in B16F10 melanoma cells was examined using chemical inhibitors. Fluorescence Activated Cell Sorting (FACS) was used to assess cell cycle distribution and PAX3 levels were monitored by immunoblotting. Treatment of cells with the GSK3ß inhibitors lithium chloride (LiCl) or BIO caused decreased cell proliferation (P=0.05) and G2/M accumulation (P=0.05), and was associated with increased PAX3 expression (P=0.05). In contrast, knockdown of PAX3 using siRNA resulted in G1 accumulation (P=0.05). Immunofluorescence techniques for exogenous BrdU incorporation and endogenous PS10H3 allowed for direct microscopic visualization and quantification of cells in S and G2/M phase respectively. Upon PAX3 knockdown, there was significantly less BrdU incorporation and PS10H3 staining (P=0.05). Lastly, cell motility assays were conducted using live-cell Differential Interference Contrast (DIC) microscopy and analyzed using T-Scratch software. Interestingly, inhibition of GSK3ß as well as PAX3 knockdown was associated with markedly decreased cellular motility and proliferation. These investigations identify GSK3ß and as an important modulator of PAX3 levels in melanoma cells, and also suggest broader roles for PAX3 in regulating the G1 to S-phase transition in melanoma. Student Poster Title Supervisor Mark Assmus Uncovering the role of topoisomerase II-beta binding protein 1 in DNA replication stress response Christopher Beavington Department/ Division Dr. Mark Glover Biochemistry University of Alberta Health Sciences Journal • April 2012 • Volume 7 • Issue 1 3 Alanna Chomyn The structural studies of bacterial lactoferrin binding protein B from Neisseria meningitides Isolation of trkA expressing and IB4-binding sensory neurons through the use of saporin Nicholas Chua A model system for complex redox enzyme maturation Alexandru Cojocaru Michelina Kierzek Using inhibition of protein N-myristoylation towards the design of a synthetically lethal treatment of B-cell lymphomas Elucidating the molecular mechanisms of heart disease-linked mutations of phospholamban Stephanie Mah Capase 1 Inhibition in inflammatory bowel disease reduces epithelial cell extrusion Scott Meyer Investigating the quinone binding site of Escherichia coli fumarate reductase Robyn Millott The novel interaction between N-myristoyltransferase 1 and calnexin Kian Parseyan Proposed improvements for intraspinal microstimulation array fabrication and insertion Amit Persad Expression of ST8Sia family in developing chick retina and their role in AP2deltamediated axonal generation Raheem Suleman Does long life come from mom? Isolation of a longevity-conferring mitochondrial DNA mutation in Caenorhabditis elegans Dr. Joanne Lemieux Biochemistry Dr. Christine Webber Anatomy Dr. Joel H. Weiner Biochemistry Dr. Luc G. Berthiaume Cell Biology Dr. Howard S. Young Biochemistry Dr. Julia Liu Medicine/ Gastroenterology Dr. Joel H. Weiner Biochemistry Dr. Marek Michalak Biochemistry Dr. Vivian K. Mushahwar Cell Biology Dr. Roseline Godbout Oncology Dr. Bernard D. Lemire Biochemistry Zachary Tan PAX3 expression in melanoma Dr. Alan Underhill Oncology Terri Waller Partial deficiency of adipose trigylceride lipase (ATGL) does not protect against diabetes-induced cardiac dysfunction Dr. Jason R.B. Dyck Pediatrics RESEARCH
Page 1 and 2: UAHSJ www.uahsj.ualberta.ca ISSN 17
Page 3: Contents Editorial Commentary OSCE:
Page 7 and 8: it has been found that PPAR-γ agon
Page 9 and 10: trioglitazone greatly inhibited inf
Page 11 and 12: types of antipsychotics used in the
Page 13 and 14: antipsychotic. Of these patients, 4
Page 15 and 16: 35. Wykoff RF. Delusions of parasit
Page 17 and 18: Embryonic Stem Cell Transplantation
Page 19 and 20: 13. Yeh ET, Zhang S, Wu HD, Korblin
Page 21 and 22: Give Me Hope | by Vina Nguyen | Med
Page 23 and 24: creative, and actually produce some
Page 25 and 26: References 1. Brett-MacLean PJ, Cav
Page 27 and 28: The arts and Humanities in Medicine
Page 29 and 30: Diverse Classrooms. English Educati
Page 31 and 32: e defined as making judgments about
Page 33 and 34: Figure 1. Dr. Albert Ross Tilley. o
Page 35 and 36: therapy were numerous. Tannic acid
Page 37 and 38: he was acknowledged with Canada and
Page 39 and 40: Thank you The UAHSJ wishes to thank

MUSA - Alberta Pharmacy Students' Association

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?