Minimum standards for training. Selecting general practitioner trainers.

The 1985 National Academy of Sciences report Nutrition Education in US Medical Schools recommended that the National Board of Medical Examiners (NBME), who develops the US Medical Licensing Examination (USMLE), cover basic nutrition knowledge. According to the NBME, the USMLE includes nutrition on their Step 1 and 2 exams; however, this coverage has been questioned. To document whether the NBME adequately addresses nutrition, the 1986 Part I and Part II and the 1993 Step 1 and step 2 exams, which replaced the Part I and II exams, were reviewed by five nutrition professionals. This review identified the nutrition-related areas of the two-part exams and how the extent of nutrition coverage changed from 1986 to 1993. Nutrition items were coded on four dimensions: 1) specific nutrition-related topic area, 2) normal or abnormal scenario, 3) related organ system, and 4) importance in clinical medicine. The percentage of nutrition-related items, as identified by the nutrition professionals, increased from 9% on the 1986 Part I exam to 11% on the 1993 Step 1 exam and from 6% on the 1986 Part II exam to 12% on the 1993 Step 2 exam. The percentage of nutrition items related to vitamin deficiencies increased from 1986 to 1993 on both halves of the exam. Nutrition coverage on the USMLE Step 1 and Step 2 seems adequate in amount, however, the content and appropriateness of the items were not evaluated. The observed increased focus on vitamin deficiencies should be further considered.

Education, Medical, Undergraduate↗

PubMed1997

Interrater concordance for faculty grading of student performances in a problem-based learning course.

PURPOSE: To determine whether it is possible for faculty to arrive at consistent, non-idiosyncratic grades in a problem-based learning (PBL) course. METHOD: Integrated Case Studies and Medical Decision Making (ICS) is the final course of the second year at the University of Pittsburgh School of Medicine. In ICS, 16 groups of nine students work in a PBL format over seven weeks. Each group is led by three faculty facilitators who, at the end of the course, independently give each student ratings for overall performance in the course and for each of seven performance categories. In 1993-94 and 1994-95, concordance in grades among the facilitators was determined by computing the intraclass correlation coefficients [ICC (3,1)] for the overall scores, the seven performance category scores, and all eight scores in aggregate. An ICC (3,1) of > or = .1 was considered indicative of statistically significant interrater concordance. An ICC (3,1) of > or = .7 was considered indicative of concordance of practical significance. RESULTS: Because the facilitators occasionally did not rate every student in every performance category, complete information was not available for all 32 groups. Statistically significant concordance was achieved in the aggregate scores in 100% of 23 groups, and in the overall scores in 90% of 18 groups. In six of the seven performance categories, concordance was achieved in at least 75% of the groups (n = 16-20). Practically significant concordance was achieved in the aggregate scores in 83% of 23 groups. CONCLUSION: The study results show that, given specific criteria by which to judge students' performances, it is possible to arrive at consistent, non-idiosyncratic grades for students in PBL courses.

Education, Medical, Undergraduate↗