Biomedical subjects
R C Bandaranayake
Publications and source records attributed to R C Bandaranayake.
Graduate medical schools in Australia.
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Using tracers to link health services to training through evaluation.
The tracer concept was applied to evaluate the delivery of family health care and the training of family health workers. A retrospective evaluation permitted linking the products of care to process, input and context, by isolating and analysing potential factors contributing to a limited number of representative concerns. Contributory learning deficiencies identified in health workers, one input to health care as well as a product of training, enabled the evaluation of training programmes to be focused on related segments of the courses. The latter were evaluated through a pathway analysis which followed the same deficiency model as the evaluation of health care. Links were thus established between the traditionally compartmentalized training and service sectors in health.
The probability of passing at resits in the Part I Fellowship examination.
The study aimed to determine the relationship of a candidate's attempt number and proximity of the aggregate score to the pass mark, individually and in combination, to the probability of passing at the next attempt at the Part I FRACS examination. The results of 36 examinations, in which 3513 candidates sat 5891 tests, were analysed. While 40.5% of all candidates who sat these examinations passed, the first attempt pass rate was 44%. Overall about one-third of the candidates who had sat the examination previously passed at the next attempt, the probability of passing remained fairly constant up to the fourth attempt and fell thereafter. As expected, the further the candidate's aggregate score was below the pass mark, the lower the probability of passing at the next attempt. Considering both attempt number and proximity to the pass mark, probability of passing decreased with successive attempts except for very weak candidates. The results indicate that, while the imposition of an upper limit on the number of resits at the examination is not justified, candidates who fall significantly below the pass mark should be advised against resitting for a reasonable period, and those who repeatedly do so should be advised against resitting for a reasonable period, and those who repeatedly do so should another career. It is suggested that feedback to the candidates about the probability of passing at the next attempt be based on the results obtained in this study.
Hippocrates to Penfield: lessons for medical education.
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Comparison of the performance of visual and verbal multiple-choice questions.
A study was carried out to determine whether multiple-choice questions based on visual trigger material, such as micrographs, photographs or radiographs, were more difficult and more discriminating than corresponding verbal questions testing: (i) the same information; (ii) different information in the same content area. Seventy-seven question triplets, each of which contained a visual (X) question, a verbal (Y) question testing the same information and a verbal (Z) question testing different information in the same content area were set in twelve Part 1 FRACS examinations. The questions were arranged in such a way that the X and Z questions in a triplet were set in the same examination, while the Y question was set in the corresponding examination of the previous or the following year. The specific outcomes studied were those on facility index and r biserial discriminating index. An analysis of variance on the data pertaining to each index did not indicate significant differences among the groups. None of the differences between pairs of mean facility indices among question groups X, Y and Z was found to be significant at P less than 0.05, nor were any of the differences between pairs of r biserial discriminating indices found to be significant at P less than 0.05. It was concluded that visual questions set in the Part 1 FRACS examination were not demonstrably more difficult or more discriminating than the corresponding verbal questions. The findings do not detract, however, from the obvious importance of visual recognition for future surgeons.
Effects of publishing multiple-choice questions on their subsequent item analysis.
A prospective study was carried out to determine what effects publication within a multiple-choice question (MCQ) book of 63 selected items from a bank had on their performance in subsequent examinations. A closely corresponding group of 63 unpublished questions set both before and after publication of the book was used as control. The specific outcomes studied were those on facility index, r biserial discriminating index and differences in performance between abler (upper 25%) and weaker (lower 25%) candidates. The mean facility index of the published questions increased significantly (P less than 0.01) after publication, while no significant change was observed in the mean facility index of control questions (P greater than 0.05) or in the mean discriminating index of published (P greater than 0.05) and control (P greater than 0.05) questions. Contrary to expectations the mean facility index of published questions increased, after publication, to a greater extent (P less than 0.01) for abler candidates than for weaker candidates. The study supports the hypothesis that publication of questions from a bank makes them easier to answer. The practice of adjusting the cut-off mark for passing according to the proportion of published questions in a given examination, however, is not justified. The findings highlight the need to advise less able candidates to make greater use of the MCQ book in preparing for an examination.
Implementing change in medical education in developing countries.
Medical schools in developing countries are constantly faced with the problem of adapting an inherited style of education to suit local needs and constraints. Often these needs have changed considerably since the curriculum was first established. Yet the difficulty of bringing about curricular changes, especially in conventional medical schools, is well known. This paper attempts to guide innovators in developing countries, but many of the suggestions are appropriate to all innovators. The issue of international standards is closely scrutinised, and their hypothetical nature revealed. The detrimental effect of national licensing examinations on curricular innovation is discussed. The futility of ad hoc changes and the need for a carefully thought out philosophy of change which leads logically to new ways of educating future professionals are stressed. Guidelines for maintaining an innovation and for evaluating its short- and long-term outcomes are developed.
How to plan a medical curriculum.
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An analysis of internship training in Sri Lanka.
The internship period is a critical phase in the continuum of training provided to medical students. An analysis was made of the tasks the intern medical officers in Sri Lanka are engaged in during their period of training in different clinical disciplines. Data was collected by direct observations by trained observers for a continuous period of 10 days and self-reporting by the interns at the two teaching hospitals and four of the provincial hospitals where interns are posted. The reliability of the data was high. The results indicated the wide differences in the learning experiences of the interns in important aspects of patient care in the different training situations. The non-availability of any guidelines to the consultants with respect to the training intended is another deficiency. The study shows an urgent need to implement a planned and monitored internship programme in the country.
Utilization of feedback from student evaluation of teachers.
Students who had completed a part of the medical course rated their teachers on a multiple choice-type questionnaire. Each teacher was provided with data from his own rating, and also the mean rating for all teachers, on each item. Six of these teachers were re-rated after a year by the next group of students who followed the same course. Positive change, often significant, was observed in the majority of instances. Such change was not, however, confined to behaviours previously hypothesized to be easily amenable to improvement on feedback. There was evidence of a tendency to unidirectional change within each teacher across most behaviours, some showing predominantly positive and others predominantly negative change at the second evaluation. These results are discussed in relation to the need for counselling following such evaluations. The second evaluation lent itself to determining the possibile existence of a 'halo effect' arising from students of one ethnic group evaluating teachers of the same ethnic group. Such an effect was found to be absent. The reliability of the measurements was tested in serveral ways.
Localization of functions in the magnocellular neurosecretory nuclei of the mammalian hypothalamus by autoradiography.
Nucleo-cytoplasmic transfer rates of RNA were used as indices of protein-synthetic activity in mammalian supraoptic and paraventricular neurones. Normal, dehydrated and lactating rats were exposed, for varying periods of time, to tritiated uridine, and autoradiographs obtained from hypothalamic blocks. Grain count and cytometry enabled a cytoplasmic/nuclear ratio of grain densities to be obtained for each neurosecretory nucleus. Comparison of these ratios, as well as the regression slopes for their increase with time of exposure to the isotope, indicated the presence of a differential response between the supraoptic and paraventricular nuclei, with the former responding more to the stimulus of dehydration, and the latter to that of lactation. The observations substantiate the view that a partial division of labour exists between the two nuclei in the elaboration of each of the mammalian neurohypophysial octapeptides, vasopressin and oxytocin.
Karyometric study of hypothalamic neurosecretory neurones under different conditions.
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Morphology of the accessory neurosecretory nuclei and of the retrochiasmatic part of the supraoptic nucleus of the rat.
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