Peter Devitt | PubMed Health

PubMed2006

Constructing multiple choice questions as a method for learning.

INTRODUCTION: Many different strategies exist to try and encourage students to increase their knowledge and understanding of a subject. This study was undertaken to measure the effect of student-based construction of multiple choice questions (MCQs) as a stimulus for the learning and understanding of topics in clinical surgery. MATERIALS AND METHODS: The study was carried out at the University of Adelaide, Australia and had 2 components. Fourth-year students were required to provide a case study during a surgical attachment and half of the group was asked to supplement this with MCQs. These students were pre- and post-tested and the effect of the additional intervention (MCQ-construction) measured. Fifth-year students were polled on their preferred methods of learning before and after a learning exercise in which they were asked to undertake a case presentation and create some MCQs. RESULTS: The MCQ questions designed by the students were of a high standard and clearly displayed an understanding of the topic concerned. The 4th-year students in the MCQ construction group showed equivalent outcomes as the case study control group. Students initially ranked MCQ-construction amongst the least stimulating methods of learning, but after the exercise their opinion was significantly more favourable, although still much less than traditional learning methodologies (tutorials, books). CONCLUSIONS: Construction of MCQs as a learning tool is an unfamiliar exercise to most students and is an unpopular learning strategy. However, students are capable of producing high quality questions, and the challenge for medical faculties is how best to use this initiative to the students' advantage.

Australia↗

PubMed2005

Surgery alone versus chemoradiotherapy followed by surgery for resectable cancer of the oesophagus: a randomised controlled phase III trial.

BACKGROUND: Resection remains the best treatment for carcinoma of the oesophagus in terms of local control, but local recurrence and distant metastasis remain an issue after surgery. We aimed to assess whether a short preoperative chemoradiotherapy regimen improves outcomes for patients with resectable oesophageal cancer. METHODS: 128 patients were randomly assigned to surgery alone and 128 patients to surgery after 80 mg/m(2) cisplatin on day 1, 800 mg/m(2) fluorouracil on days 1-4, with concurrent radiotherapy of 35 Gy given in 15 fractions. The primary endpoint was progression-free survival. Secondary endpoints were overall survival, tumour response, toxic effects, patterns of failure, and quality of life. Analysis was done by intention to treat. FINDINGS: Neither progression-free survival nor overall survival differed between groups (hazard ratio [HR] 0.82 [95% CI 0.61-1.10] and 0.89 [0.67-1.19], respectively). The chemoradiotherapy-and-surgery group had more complete resections with clear margins than did the surgery-alone group (103 of 128 [80%] vs 76 of 128 [59%], p=0.0002), and had fewer positive lymph nodes (44 of 103 [43%] vs 69 of 103 [67%], p=0.003). Subgroup analysis showed that patients with squamous-cell tumours had better progression-free survival with chemoradiotherapy than did those with non-squamous tumours (HR 0.47 [0.25-0.86] vs 1.02 [0.72-1.44]). However, the trial was underpowered to determine the real magnitude of benefit in this subgroup. INTERPRETATION: Preoperative chemoradiotherapy with cisplatin and fluorouracil does not significantly improve progression-free or overall survival for patients with resectable oesophageal cancer compared with surgery alone. However, further assessment is warranted of the role of chemoradiotherapy in patients with squamous-cell tumours.

Adult↗