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Plewa MC, Ledrick DJ, Jenkins K, Orqvist A, McCrea M. Can USMLE and COMLEX-USA Scores Predict At-Risk Emergency Medicine Residents' Performance on In-Training Examinations? Cureus 2024; 16:e58684. [PMID: 38651085 PMCID: PMC11033967 DOI: 10.7759/cureus.58684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 04/25/2024] Open
Abstract
PURPOSE The United States Medical Licensing Examination (USMLE) and Comprehensive Osteopathic Medical Licensing Examination (COMLEX) scores are standard methods used to determine residency candidates' medical knowledge. The authors were interested in using the USMLE and COMLEX part 2 scores in our emergency medicine (EM) residency program to identify at-risk residents who may have difficulty on the in-training exam (ITE) and to determine the cutoff values under which an intern could be given an individualized study plan to ensure medical knowledge competency. METHODS The authors abstracted the USMLE and COMLEX part 2 scores and the American Board of Emergency Medicine (ABEM) ITE scores for a cohort of first-year EM residents graduating years 2010-2022, converting raw scores to percentiles, and compared part 2 and ABEM ITE scores with Pearson's correlation, a Bland-Altman analysis of bias and 95% limits of agreement, and ROC analysis to determine optimal the cut-off values for predicting ABEM ITE < 50th percentile and the estimated test characteristics. RESULTS Scores were available for 152 residents, including 93 USMLE and 88 COMLEX exams. The correlations between part 2 scores and ABEM ITE were r = 0.36 (95%CI: 0.17, 0.52; p < 0.001) for USMLE and r = 0.50 (95%CI: 0.33, 0.64; p < 0.001) for COMLEX. Bias and limits of agreement for both part 2 scores were -14 ± 63% for USMLE and 13 ± 50% for COMLEX in predicting the ABEM ITE scores. USMLE < 37th percentile and COMLEX < 53rd percentile identified 42% (N = 39) and 27% (N = 24) of EM residents, respectively, as at risk, with a sensitivity of 61% and 49% and specificity of 71% and 92%, respectively. CONCLUSION USMLE and COMLEX part 2 scores have a very limited role in identifying those at risk of low ITE performance, suggesting that other factors should be considered to identify interns in need of medical knowledge remediation.
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Affiliation(s)
- Michael C Plewa
- Emergency Medicine, Mercy Health - St. Vincent Medical Center, Toledo, USA
| | - David J Ledrick
- Emergency Medicine, Mercy Health - St. Vincent Medical Center, Toledo, USA
| | - Kenneth Jenkins
- Emergency Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, USA
| | - Aaron Orqvist
- Emergency Medicine, Mercy Health - St. Vincent Medical Center, Toledo, USA
| | - Michael McCrea
- Emergency Medicine, Mercy Health - St. Vincent Medical Center, Toledo, USA
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Beeson MS, Barton MA, Reisdorff EJ, Carter WA, Gausche‐Hill M, Gorgas DL, Joldersma KB, Santen SA. Comparison of performance data between emergency medicine 1-3 and 1-4 program formats. J Am Coll Emerg Physicians Open 2023; 4:e12991. [PMID: 37304857 PMCID: PMC10257037 DOI: 10.1002/emp2.12991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 04/24/2023] [Accepted: 05/03/2023] [Indexed: 06/13/2023] Open
Abstract
Objective This study compares performance data from physicians completing 3-year versus 4-year emergency medicine residency training programs. Currently, there are 2 training formats and little is known about objective performance differences. Methods This was a retrospective cross-sectional analysis of emergency residents and physicians. Multiple analyses were conducted comparing physicians' performances, including Accreditation Council of Graduate Medical Education Milestones and American Board of Emergency Medicine In-training Examination (ITE), Qualifying Examination (QE), Oral Certification Examination (OCE), and program extensions from 3-year and 4-year residency programs. Some confounding variables were not or could not be considered, such as rationale for medical students to choose one format over another, as well as application and final match rates. Results Milestone scores are higher for emergency medicine 3 residents in 1-3 programs (3.51) versus emergency medicine 3 residents in 1-4 programs (3.07; P < 0.001, d = 1.47) and highest for emergency medicine 4 residents (3.67). There was no significant difference in program extension rates (emergency medicine 1-3, 8.1%; emergency medicine 1-4, 9.6%; P = 0.05, ω = 0.02). ITE scores were higher for emergency medicine 1, 2, and 3 residents from 1-3 programs and emergency medicine 4 residents from 1-4 programs scored highest. Mean QE score was slightly higher for emergency 1-3 physicians (83.55 vs 83.00; P < 0.01, d = 0.10). QE pass rate was higher for emergency 1-3 physicians (93.1% vs 90.8%; P < 0.001, ω = 0.08). Mean OCE score was slightly higher for emergency 1-4 physicians (5.67 vs 5.65; P = 0.03, d = -0.07) but did not reach a priori statistical significance (α < 0.01). OCE pass rate was also slightly higher for emergency 1-4 physicians (96.9% vs 95.5%; P = 0.06, ω = -0.07) but also non-significant. Conclusions These results suggest that although performance measures demonstrate small differences between physicians from emergency medicine 1-3 and 1-4 programs, these differences are limited in their ability to make causal claims about performance on the basis of program format alone.
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Affiliation(s)
| | | | | | - Wallace A. Carter
- Department of Emergency MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Marianne Gausche‐Hill
- Department of Emergency MedicineHarbor‐University of California Los Angeles, Los Angeles County Emergency Medical Services AgencyLos AngelesCaliforniaUSA
| | - Diane L. Gorgas
- Department of Emergency MedicineThe Ohio State Wexner Medical CenterColumbusOhioUSA
| | | | - Sally A. Santen
- Department of Emergency MedicineUniversity of Cincinnati College of Medicine, Cincinnati, Ohio and Department of Emergency Medicine, Virginia Commonwealth UniversityRichmondVirginiaUSA
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Shirkhodaie C, Avila S, Seidel H, Gibbons RD, Arora VM, Farnan JM. The Association Between USMLE Step 2 Clinical Knowledge Scores and Residency Performance: A Systematic Review and Meta-Analysis. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:264-273. [PMID: 36512984 DOI: 10.1097/acm.0000000000005061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE With the change in Step 1 score reporting, Step 2 Clinical Knowledge (CK) may become a pivotal factor in resident selection. This systematic review and meta-analysis seeks to synthesize existing observational studies that assess the relationship between Step 2 CK scores and measures of resident performance. METHOD The authors searched MEDLINE, Web of Science, and Scopus databases using terms related to Step 2 CK in 2021. Two researchers identified studies investigating the association between Step 2 CK and measures of resident performance and included studies if they contained a bivariate analysis examining Step 2 CK scores' association with an outcome of interest: in-training examination (ITE) scores, board certification examination scores, select Accreditation Council for Graduate Medical Education core competency assessments, overall resident performance evaluations, or other subjective measures of performance. For outcomes that were investigated by 3 or more studies, pooled effect sizes were estimated with random-effects models. RESULTS Among 1,355 potential studies, 68 met inclusion criteria and 43 were able to be pooled. There was a moderate positive correlation between Step 2 CK and ITE scores (0.52, 95% CI 0.45-0.59, P < .01). There was a moderate positive correlation between Step 2 CK and ITE scores for both nonsurgical (0.59, 95% CI 0.51-0.66, P < .01) and surgical specialties (0.41, 95% CI 0.33-0.48, P < .01). There was a very weak positive correlation between Step 2 CK scores and subjective measures of resident performance (0.19, 95% CI 0.13-0.25, P < .01). CONCLUSIONS This study found Step 2 CK scores have a statistically significant moderate positive association with future examination scores and a statistically significant weak positive correlation with subjective measures of resident performance. These findings are increasingly relevant as Step 2 CK scores will likely become more important in resident selection.
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Affiliation(s)
- Camron Shirkhodaie
- C. Shirkhodaie is a medical student, Pritzker School of Medicine, University of Chicago, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-4279-3251
| | - Santiago Avila
- S. Avila is a medical student, Pritzker School of Medicine, University of Chicago, Chicago, Illinois; ORCID: https://orcid.org/0000-0003-3633-4304
| | - Henry Seidel
- H. Seidel is a medical student, Pritzker School of Medicine, University of Chicago, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-7364-1365
| | - Robert D Gibbons
- R.D. Gibbons is professor, Center for Health Statistics and Departments of Medicine and Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Vineet M Arora
- V.M. Arora is professor, Department of Medicine, University of Chicago Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-4745-7599
| | - Jeanne M Farnan
- J.M. Farnan is professor, Department of Medicine, University of Chicago Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-1138-9416
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Morgan DE. Use of Attending Radiologist Reviews of Resident Clinical Performance to Predict Outcomes on the American Board of Radiology Qualifying (Core) Exam: A Call to Action. Acad Radiol 2022; 29:1727-1729. [PMID: 36050263 DOI: 10.1016/j.acra.2022.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 07/31/2022] [Indexed: 11/20/2022]
Affiliation(s)
- Desiree E Morgan
- University of Alabama at Birmingham, Department of Radiology, JTN456, 619 South 19th Street, Birmingham, AL 35249.
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Raborn LN, Janis JE. Current Views on the New United States Medical Licensing Examination Step 1 Pass/Fail Format: A Review of the Literature. J Surg Res 2022; 274:31-45. [PMID: 35121548 DOI: 10.1016/j.jss.2022.01.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/20/2021] [Accepted: 01/02/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Residency programs have historically used numerical Step 1 scores to screen applicants, making it a career-defining, high-stakes examination. Step 1 scores will be reported as pass/fail starting in January 2022, fundamentally reshaping the residency application review process. This review aimed to identify opinions of physicians and medical students about the new format, identify arguments in support of or against the change, and determine the implications of this change on the residency selection process. METHODS A comprehensive PubMed review was performed in May 2021 to identify articles that discussed the new Step 1 format. Non-English and duplicate articles were excluded. Data collected from each article included publication year, specialty, subjects, and key findings. RESULTS A total of 81 articles were included, 26 of which discussed the impact of the new format within surgical fields (32.1%). Remaining articles discussed the implications within the medical community as a whole (n = 33, 40.7%) and nonsurgical fields (n = 22, 27.2%). Studies suggest Program Directors will rely on Step 2 Clinical Knowledge (CK) scores, medical school reputation, applicant familiarity, Dean's letters, recommendation letters, and research in lieu of numerical Step 1 scores. In addition, concerns have been raised that the new format will disadvantage international, osteopathic, and minority applicants while increasing stress surrounding Step 2 CK. CONCLUSIONS Within the medical community, there are concerns that Step 2 CK will be used to substitute Step 1 and that resident diversity will diminish due to the new Step 1 format. Holistic candidate consideration will be increasingly important.
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Affiliation(s)
- Layne N Raborn
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Jeffrey E Janis
- Department of Plastic and Reconstructive Surgery, Wexner Medical Center, Ohio State University, Columbus, Ohio.
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Cohen ER. Are USMLE Scores Valid Measures for Chief Resident Selection? J Grad Med Educ 2020; 12:441-446. [PMID: 32879684 PMCID: PMC7450744 DOI: 10.4300/jgme-d-19-00782.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/31/2020] [Accepted: 02/29/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The US Medical Licensing Examination (USMLE) Step 1 and Step 2 scores are often used to inform a variety of secondary medical career decisions, such as residency selection, despite the lack of validity evidence supporting their use in these contexts. OBJECTIVE We compared USMLE scores between non-chief residents (non-CRs) and chief residents (CRs), selected based on performance during training, at a US academic medical center that sponsors a variety of graduate medical education programs. METHODS This was a retrospective cohort study of residents' USMLE Step 1 and Step 2 Clinical Knowledge (CK) scores from 2015 to 2020. The authors used archived data to compare USMLE Step 1 and Step 2 CK scores between non-CR residents in each of the eligible programs and their CRs during the 6-year study period. RESULTS Thirteen programs enrolled a total of 1334 non-CRs and 211 CRs over the study period. There were no significant differences overall between non-CRs and CRs average USMLE Step 1 (239.81 ± 14.35 versus 240.86 ± 14.31; P = .32) or Step 2 scores (251.06 ± 13.80 versus 252.51 ± 14.21; P = .16). CONCLUSIONS There was no link between USMLE Step 1 and Step 2 CK scores and CR selection across multiple clinical specialties over a 6-year period. Reliance on USMLE Step 1 and 2 scores to predict success in residency as measured by CR selection is not recommended.
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Yang A, Gilani C, Saadat S, Murphy L, Toohey S, Boysen‐Osborn M. Which Applicant Factors Predict Success in Emergency Medicine Training Programs? A Scoping Review. AEM EDUCATION AND TRAINING 2020; 4:191-201. [PMID: 32704588 PMCID: PMC7369487 DOI: 10.1002/aet2.10411] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/30/2019] [Accepted: 11/04/2019] [Indexed: 05/30/2023]
Abstract
BACKGROUND Program directors (PDs) in emergency medicine (EM) receive an abundance of applications for very few residency training spots. It is unclear which selection strategies will yield the most successful residents. Many authors have attempted to determine which items in an applicant's file predict future performance in EM. OBJECTIVES The purpose of this scoping review is to examine the breadth of evidence related to the predictive value of selection factors for performance in EM residency. METHODS The authors systematically searched four databases and websites for peer-reviewed and gray literature related to EM admissions published between 1992 and February 2019. Two reviewers screened titles and abstracts for articles that met the inclusion criteria, according to the scoping review study protocol. The authors included studies if they specifically examined selection factors and whether those factors predicted performance in EM residency training in the United States. RESULTS After screening 23,243 records, the authors selected 60 for full review. From these, the authors selected 15 published manuscripts, one unpublished manuscript, and 11 abstracts for inclusion in the review. These studies examined the United States Medical Licensing Examination (USMLE), Standardized Letters of Evaluation, Medical Student Performance Evaluation, medical school attended, clerkship grades, membership in honor societies, and other less common factors and their association with future EM residency training performance. CONCLUSIONS The USMLE was the most common factor studied. It unreliably predicts clinical performance, but more reliably predicts performance on licensing examinations. All other factors were less commonly studied and, similar to the USMLE, yielded mixed results.
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Affiliation(s)
- Allen Yang
- Department of Emergency MedicineUniversity of California, IrvineIrvineCA
| | - Chris Gilani
- Department of Emergency MedicineUniversity of California, IrvineIrvineCA
| | - Soheil Saadat
- Department of Emergency MedicineUniversity of California, IrvineIrvineCA
| | - Linda Murphy
- Health Science Library OrangeUniversity of California, IrvineIrvineCA
| | - Shannon Toohey
- Department of Emergency MedicineUniversity of California, IrvineIrvineCA
| | - Megan Boysen‐Osborn
- Department of Emergency MedicineUniversity of California, IrvineIrvineCA
- School of MedicineUniversity of California, IrvineIrvineCA
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Olson AS, Williamson K, Hartman N, Cheema N, Olson N. The Correlation Between Emergency Medicine Residents' Grit and Achievement. AEM EDUCATION AND TRAINING 2020; 4:24-29. [PMID: 31989067 PMCID: PMC6965685 DOI: 10.1002/aet2.10399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/23/2019] [Accepted: 09/30/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Early identification of emergency medicine (EM) residents who struggle with educational attainment is difficult. In-training examination (ITE) scores predict success on the American Board of Emergency Medicine (ABEM) Qualifying Examination; however, results are not available until late in the academic year. The noncognitive trait "grit," defined as "perseverance and passion for long-term goals," predicts achievement in high school graduation rates, undergraduate GPA, and gross anatomy. Grit-S is a validated eight-question scale scored 1 to 5; the average of responses represents a person's grit. Our objective was to determine the correlation between EM resident Grit-S scores and achievement, as measured by MCAT percentiles, ITE scores, and remediation rates. STUDY DESIGN AND METHODS This was a 1-year prospective, multicenter trial involving ten EM residencies from 2017 to 2018. Subjects were PGY-1 to -4 EM residents. Grit-S scores, MCAT percentile, remediation rates, ITE scores, and the ITE score's prediction of passing the ABEM Qualifying Examination were collected. Correlation coefficients were computed to assess the relationship between residents' grit and achievement. RESULTS A total 385 of 434 (88.7%) residents participated who completed the Grit-S as part of a larger study. The mean Grit-S score was 3.62. Grit positively correlated with the predicted likelihood of passing the ABEM Qualifying Examination (r = 0.134, n = 382, p = 0.025). There was no correlation between grit and remediation (r = -0.04, n = 378, p = 0.46) or grit and MCAT percentiles (r =- 0.08, n = 262, p = 0.22). CONCLUSIONS The positive correlation between Grit-S scores and percent likelihood of passing the ABEM Qualifying Examination demonstrates grit's potential to assist residency leadership in early identification of residents who may attain a lower ITE score.
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Affiliation(s)
- Adriana Segura Olson
- Department of MedicineSection of Emergency MedicineUniversity of ChicagoChicagoIL
- Department of Emergency MedicineUniversity of Texas Health San AntonioSan AntonioTX
| | - Kelly Williamson
- Department of Emergency MedicineAdvocate Christ Medical CenterOak LawnIL
| | - Nicholas Hartman
- Department of Emergency MedicineWake Forest School of MedicineWinston‐SalemNC
| | - Navneet Cheema
- Department of MedicineSection of Emergency MedicineUniversity of ChicagoChicagoIL
| | - Nathan Olson
- Department of MedicineSection of Emergency MedicineUniversity of ChicagoChicagoIL
- Department of Emergency/Military MedicineSan Antonio Military Medical CenterFort Sam HoustonTX
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Jabbar A, Nabi S, Shafique K, Arshad A. The USMLE Step 1 Pass/Fail Reporting Proposal: Another Opinion. Acad Radiol 2019; 26:1408. [PMID: 31447260 DOI: 10.1016/j.acra.2019.07.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022]
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Amirhajlou L, Sohrabi Z, Alebouyeh MR, Tavakoli N, Haghighi RZ, Hashemi A, Asoodeh A. Application of data mining techniques for predicting residents' performance on pre-board examinations: A case study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2019; 8:108. [PMID: 31334260 PMCID: PMC6615122 DOI: 10.4103/jehp.jehp_394_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 02/01/2019] [Indexed: 05/24/2023]
Abstract
CONTEXT Predicting residents' academic performance is critical for medical educational institutions to plan strategies for improving their achievement. AIMS This study aimed to predict the performance of residents on preboard examinations based on the results of in-training examinations (ITE) using various educational data mining (DM) techniques. SETTINGS AND DESIGN This research was a descriptive cross-sectional pilot study conducted at Iran University of Medical Sciences, Iran. PARTICIPANTS AND METHODS A sample of 841 residents in six specialties participating in the ITEs between 2004 and 2014 was selected through convenience sampling. Data were collected from the residency training database using a researcher-made checklist. STATISTICAL ANALYSIS The analysis of variance was performed to compare mean scores between specialties, and multiple-regression was conducted to examine the relationship between the independent variables (ITEs scores in postgraduate 1st year [PGY1] to PG 3rd year [PGY3], sex, and type of specialty training) and the dependent variable (scores of postgraduate 4th year called preboard). Next, three DM algorithms, including multi-layer perceptron artificial neural network (MLP-ANN), support vector machine, and linear regression were utilized to build the prediction models of preboard examination scores. The performance of models was analyzed based on the root mean square error (RMSE) and mean absolute error (MAE). In the final step, the MLP-ANN was employed to find the association rules. Data analysis was performed in SPSS 22 and RapidMiner 7.1.001. RESULTS The ITE scores on the PGY-2 and PGY-3 and the type of specialty training were the predictors of scores on the preboard examination (R 2 = 0.129, P < 0.01). The algorithm with the overall best results in terms of measuring error values was MLP-ANN with the condition of ten-fold cross-validation (RMSE = 0.325, MAE = 0.212). Finally, MLP-ANN was utilized to find the efficient rules. CONCLUSIONS According to the results of the study, MLP-ANN was recognized to be useful in the evaluation of student performance on the ITEs. It is suggested that medical, educational databases be enhanced to benefit from the potential of DM approach in the identification of residents at risk, allowing instructors to offer constructive advice in a timely manner.
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Affiliation(s)
- Leila Amirhajlou
- Department of Medical Education, Iran University of Medical Sciences, Tehran, Iran
| | - Zohre Sohrabi
- Department of Medical Education, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Reza Alebouyeh
- Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Nader Tavakoli
- Department of Emergency Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Roghye Zare Haghighi
- Department of Deputy of Specialty and Subspecialty Education, Iran University of Medical Sciences, Tehran, Iran
| | - Akram Hashemi
- Department of Medical Ethics, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Asoodeh
- Health Laboratories Administration, Birjand University of Medical Sciences, Birjand, Iran
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