The Fellowship of the Royal College of Radiologists (FRCR) examination: a review of the evidence

The Fellowship of the Royal College of Radiologists (FRCR) examination is the professional qualification that is essential for career progression in clinical radiology within the UK. It is also important for career progression in many countries internationally. The FRCR has evolved and changed over the last decade. In this systematic review we appraise and summarise the available data relating to the FRCR emphasising the published evidence regarding the validity, reliability, and acceptability of this examination. Comparison is made to other equivalent medical examinations, as well as a more recently published commissioned external review of the FRCR examinations. The Clinical Radiology Part 2B (CR2B) examination in its pre-existing format is reliable, valid, and acceptable. Recommendations from the commissioned external review are based primarily on expert opinion, with a limited evidence base comprising data from a small sample acquired during a single examination sitting and without peer review. Unlike the CR2B examination, there is little evidence regarding assessment of the CR1 and CR2 examinations. Both the CR1 and CR2 examinations are currently in the process of undergoing major changes to their formats. Blueprinting items to the curriculum might improve acceptability. Other changes may improve transparency and reliability of these assessments. Our analysis and many aspects of the external review may provide pointers regarding how the upcoming data produced by the "automated" FRCR examinations can be further analysed to provide a more robust evaluation.

Fixed-ratio pausing: Joint effects of past reinforcer magnitude and stimuli correlated with upcoming magnitude

Pigeons responded on fixed-ratio schedules ending in small or large reinforcers (grain presentations of different duration) interspersed within each session. In mixed-schedule conditions, the response key was lit with a single color throughout the session, and pausing was directly related to the past reinforcer (longer pauses after large reinforcers than after small ones). In multiple-schedule conditions, different colors accompanied the ratios ending in small and large reinforcers, and pausing was affected by the upcoming reinforcer as well as the past one. Pauses were shorter before large reinforcers than before small ones, but they continued to be longer after large reinforcers than after small ones. The influence of the past reinforcer was modulated by the magnitude of the upcoming reinforcer; in the presence of the stimulus before the small reinforcer, the effect of the past reinforcer was enhanced relative to its effect in the stimulus before the large reinforcer. These results show that pausing between ratios is jointly determined by two competing factors: past conditions of reinforcement and stimuli correlated with upcoming conditions.

Reductions in shock frequency and response effort as factors in reinforcement by timeout from avoidance

Rats' presses on one lever canceled shocks programmed after variable cycles, while presses on a second lever occasionally produced a 2-min timout during which the shock-delection schedule was suspended and its correlated stimuli removed. These concurrent schedules of avoidance and timeout were embedded in a multiple schedule whose components differed, within and across conditions, in terms of the programmed shock rate associated with the shock-deletion schedule. Analyses based on the generalized matching law suggest that the reduction in the response requirement correlated with termination of the avoidance schedule was a more important factor in the reinforcing effectiveness of timeout than was shock-frequency reduction, at least in 2 of 3 rats. After training in each condition, responding on the timeout lever was extinguished by withholding timeouts in both components over seven sessions. Resistance to extinction varied directly with the rates of both shock-frequency reduction and avoidance-response reduction experienced during training. Although reduction in response effort appeared to dominate shock-frequency reduction in the maintenance of responding, neither factor had a clear advantage in predicting the course of extinction.

De novo lipogenesis predicts short-term body-composition response by bioelectrical impedance analysis to oral nutritional supplements in HIV-associated wasting

We studied the effects of enteral supplements on protein and energy intakes, body composition, energy expenditure, and gastrointestinal histology in 49 subjects with human immunodeficiency virus-associated weight loss (12.7 +/- 0.9% of body wt). We also determined whether a stable-isotope mass spectrometric measurement at baseline might predict the short-term response of fat-free mass (FFM) measured by bioelectrical impedance analysis. Thirty-nine subjects completed the study after being randomly assigned to receive either a whole-protein-based (n = 22) or a peptide-based (n = 17) formula. A nonsupplemented, nonrandomly assigned group (n = 13) was followed concurrently. Both formulas were well tolerated. Voluntary intakes of energy and protein from nonsupplement sources decreased significantly during supplementation [by 819-1638 kJ (196-382 kcal)/d and 5.6-14.4 g protein/d, respectively; P < 0.01] but to a lesser extent than the intake from the supplement [2300-2510 kJ(550-600 kcal)/d and 19-28 g protein/d, respectively], so that net increases in intakes of protein and energy (P < 0.03), as well as of several vitamins and trace elements were increased. Nevertheless, the mean FFM did not increase for the group as a whole, although there was considerable interindividual heterogeneity. Changes in FFM at 6 wk were significantly inversely correlated (r = 0.65, P < 0.01) with baseline synthesis of fat (de novo hepatic lipogenesis), but not with other potential measures of energy intake (insulin-like growth factor 1 or its binding protein) or inflammation (soluble tumor necrosis factor receptors I or II). The prospective identification of FFM response by measurement of de novo hepatic lipogenesis supported the hypothesis that the subset of wasting patients whose FFM is unresponsive to nutrient supplementation have altered nutrient metabolism.