Letters to the Editor

Kingdom believe that they have received insufficient anatomy teaching at medical school (Fitzgerald et al. 2008). In the light of such findings, I have been unsurprised as a medical student to find myself and other colleagues often searching for additional resources to further develop our anatomical knowledge in addition to core teaching. One method used to fill the deficit of anatomy teaching that has received considerable success is peer-assisted learning (PAL) (Hall et al. 2013). At Cardiff University, students in the third and fourth years of the medical course have developed a new student-led society called SIMA Wales. This PAL society provides a series of lectures for the first and second year students covering the gross anatomy of the various regions of the body. The lectures are typically held in the weeks preceding the end of year anatomy exams and are held in a relaxed environment, with free interaction from the audience. At a recent lecture, 111 students attended and 78 provided optional feedback. When asked to rate how useful the lecture was for their anatomy learning, the mean score received was 7.5 out of 10. Qualitative analysis revealed that the students particularly enjoyed interacting with the peers who had been in their position only a few years ago, and especially valued the learning techniques such as mnemonics which the teachers had passed onto them. Finally, the teachers themselves benefitted from the experience with feedback such as ‘‘presenting was a great experience that really gives you confidence’’ and ‘‘it was very useful for refreshing my anatomy knowledge’’. In conclusion, given the success of PAL schemes in delivering anatomy teaching to medical undergraduates, it would seem that PAL offers a valuable (and inexpensive) option to supplement anatomy learning. Therefore, the expansion of such schemes, under the quality-control of academic staff, should be encouraged. Ryan Preece, School of Medicine, Cardiff University, 5 Heol Castell Pigyn, Abergwili, Carmarthen, SA31 2JJ, UK. E-mail: [email protected] Declaration of interest: Ryan Preece was President of SIMA Wales 2012–2013.

References Fitzgerald J, White M, Tang S, Maxwell-Armstrong C, James D. 2008. Are we teaching sufficient anatomy at medical school? The opinions of newly qualified doctors. Clin Anat 21:718–724. Hall S, Lewis M, Border S, Powell M. 2013. Near-peer teaching in clinical neuroanatomy. Clin Teach 10:230–235.

Assessment overload? Dear Sir Whilst the concept of curriculum overload has been around for a while, I wonder if we are now moving to a phase of Assessment Overload. Taking for example final year medical students, they typically rotate throughout the year to a number

of specialities and undergo work place-based assessments (WPBA), either summative or formative. These may include directly observed procedural skills (DOPS), mini-clinical examinations (mini-CEX) and team assessment of behaviour (TAB), this list of acronyms could go on. Students may also be expected to produce a research or reflective report based on their elective which is summatively assessed. Students are then expected to ‘pass’ an Immediate Life Support (ILS) course, assessed by a Cas-Test (Simulated cardiac arrest) and then at the end of the year attend their final examinations, usually incorporating an Objective Structured Clinical Examination (OSCE) and depending on their medical school written examinations. Whilst this is already considered stressful enough for medical students (Radcliffe & Lester 2003), current political drive now includes the about-to-become mandatory Prescribing Safety Assessment (PSA) and following the publication of the Shape of Training Review and the possibility of full registration occurring at the end of medical school (Shape of Training 2013), already mumblings of a national medical school ‘‘exit’’ examination are being heard. Meanwhile, to secure a Foundation Post in the UK students are ranked according to their performance on the Situational Judgement Test (SJT), sat in their final year at medical school, which counts for 50% of their mark towards their ranking (UKFPO 2013). Whilst undoubtedly assessment is vital, have we gone too far and are now overloading our medical students with assessments? Dr. Craig Brown, Clinical Teaching Fellow, University of Aberdeen, Polwarth Building Foresterhill, Aberdeen AB25 2ZD, UK. E-mail: [email protected]

Declaration of interest: The author reports no conflicts of interest.

References Radcliffe C, Lester H. 2003. Perceived stress during undergraduate medical training: A qualitative study. Med Educ 37:32–38. Shape of Training. 2013. Shape of training: Securing the future of excellent patient care. London: GMC. UK Foundation Programme Office (UKFPO). 2013. FP/AFP 2014 applicant’s handbook. [Accessed 14 May 2014] Available from http://www. foundationprogramme.nhs.uk/pages/medical-students.

The diagnostic skills of fourteen-year olds Dear Sir I recently led an ‘‘academic taster session’’ for a group of 14–15 years old school students during a day programme to improve access to higher education. Participants had been identified as having strong academic potential despite coming from schools that did not traditionally send students to university. I decided to see how they would fare when asked to make a diagnosis in a medical case.

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Letters to the Editor

To set the scene, I announced that a man sat in front of them, breathless and unable to speak. No other medical personnel were present, and they alone could work out the diagnosis and treat the patient. The clues they had were four envelopes, which contained an ECG, a chest X-ray, blood and sputum cultures, and the results of an arterial blood gas. The students were given minimal background information: simple guides to interpreting the basics of each investigation; a brief medical glossary to explain terms such as acidosis, consolidation and tachycardia; a list of eleven possible diagnoses with expected corresponding findings in the clues; and the clues themselves. They were allowed to see each clue for up to five minutes, but could not see the same clue again once their time with it had elapsed. Following initial trepidation, they quickly got to work in groups of four. The underlying diagnosis was an infective exacerbation of COPD, with the clues corresponding to this (e.g. an ECG showing sinus tachycardia and a hyper-expanded chest X-ray). Satisfaction was audible as pennies dropped around the room, students spotting what they were looking for in each ‘‘clue’’. Three out of the four groups arrived at the correct diagnosis, and the final group came close, but wrongly identified the case as acute respiratory distress syndrome due to misinterpretation of the chest X-ray. Despite no medical background, the students were able to suggest oxygen, antibiotics and inhalers as the treatment they would want to provide. Diagnosing medical cases provides potent opportunities to raise scientific curiosity and develop problem-solving skills, even to those years away from considering starting medical school. I left the session impressed at the students’ abilities and reinvigorated in enthusiasm for teaching. Dr Stephen P. Hibbs, Oxford University Clinical Academic Graduate School, John Radcliffe Hospital, Oxford, OX3 9DU, UK. Tel: 07749 525 939; E-mail: [email protected]

Declaration of interest: The author reports no declaration of interest.

A call for greater transparency in the evidence base supporting the BMAT

Dear Sir The BioMedical Admissions Test (BMAT) and the United Kingdom Clinical Aptitude Test (UKCAT) are the two major aptitude tests used for the selection of medical students in the UK. The importance of using evidence-based practices in admissions processes is undeniable, as is the need for the evidence to be more transparent and accessible. Whilst the predictive validity of the UKCAT has been well established by peer-reviewed publications, there has been a relative 302

paucity in the peer-reviewed evidence supporting the use of the BMAT. Accordingly, we advocate that the evidence base for the BMAT be expanded. Specifically, it is necessary to improve access to existing unpublished data held by admissions offices, and for the effectiveness of the BMAT to be assessed using rigorous, peer-approved research methods. The advantage of promoting this is two-fold. Firstly, the peer-reviewed evidence evaluating the predictive validity of the BMAT (Emery & Bell 2009), albeit convincing, is solely limited to the University of Cambridge, which follows a traditional course structure with a prominent pre-clinical/clinical divide. Further studies to probe the applicability of the BMAT at institutions with different course styles will provide a more comprehensive overview on its effectiveness in candidate selection. This issue is particularly pertinent as institutions such as the University of Leeds and Brighton and Sussex Medical School begin incorporating the BMAT into their admissions processes. Secondly, much of the evidence pertaining to the BMAT is provided by its developers, Cambridge Assessment. The use of the BMAT will be more robustly supported by peer-reviewed articles written by independent authors than by reports published by Cambridge Assessment, who may have vested interests in the outcomes of any study they carry out. To conclude, we are concerned by the apparent disparities in the evidence base supporting the UKCAT and the BMAT. We believe that evidence-based practices involving the use of the BMAT should be ultimately held to the same standards as that of the UKCAT. Sanjeev Ramachandran*, Imperial College London, South Kensington Campus, Exhibition Road, London, SW7 2AZ, UK. Harish Venkatesh*, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK. E-mail: [email protected]

Declaration of interest: The authors report no conflicts of interest.

Reference Emery JL, Bell JF. 2009. The predictive validity of the BioMedical Admissions Test for pre-clinical examination performance. Med Edu 43(6):557–564.

Ubiquitous-based testing in medical education

Dear Sir Ubiquitous-based testing (UBT) is a variation of electronic assessment using smart devices (Huh 2012). UBT provides the *Joint first authors

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