Assessment approaches in undergraduate health professions education: towards the development of feasible assessment approaches for low-resource settings

BACKGROUND

Feasible and effective assessment approaches to measuring competency in health sciences are vital in competency-based education. Educational programmes for health professions in low- and middle-income countries are increasingly adopting competency-based education as a strategy for training health professionals. Importantly, the organisation of assessments and assessment approaches must align with the available resources and still result in the fidelity of implementation. A review of existing assessment approaches, frameworks, models, and methods is essential for the development of feasible and effective assessment approaches in low-resource settings.

METHODS

Published literature was sourced from 13 electronic databases. The inclusion criteria were literature published in English between 2000 and 2022 about assessment approaches to measuring competency in health science professions. Specific data relating to the aims of each study, its location, population, research design, assessment approaches (including the outcome of implementing such approaches), frameworks, models, and methods were extracted from the included literature. The data were analysed through a multi-step process that integrated quantitative and qualitative approaches.

RESULTS

Many articles were from the United States and Australia and reported on the development of assessment models. Most of the articles included undergraduate medical or nursing students. A variety of models, theories, and frameworks were reported and included the Ideal model, Predictive Learning Assessment model, Amalgamated Student Assessment in Practice (ASAP) model, Leadership Outcome Assessment (LOA) model, Reporter-Interpreter-Manager-Educator (RIME) framework, the Quarter model, and the model which incorporates four assessment methods which are Triple Jump Test, Essay incorporating critical thinking questions, Multistation Integrated Practical Examination, and Multiple Choice Questions (TEMM) model. Additional models and frameworks that were used include the Entrustable Professional Activities framework, the System of Assessment framework, the Reporter-Interpreter-Manager-Educator (RIME) framework, the Clinical Reasoning framework (which is embedded in the Amalgamated Student Assessment in Practice (ASAP) model), Earl's Model of Learning, an assessment framework based on the Bayer-Fetzer Kalamazoo Consensus Statement, Bloom's taxonomy, the Canadian Medical Education Directions for Specialists (CanMEDS) Framework, the Accreditation Council for Graduate Medical Education (ACGME) framework, the Dreyfus Developmental Framework, and Miller's Pyramid.

CONCLUSION

An analysis of the assessment approaches, frameworks, models, and methods applied in health professions education lays the foundation for the development of feasible and effective assessment approaches in low-resource settings that integrate competency-based education.

TRIAL REGISTRATION

This study did not involve any clinical intervention. Therefore, trial registration was not required.

Looking beneath the surface of a preceptor-training programme through a realist evaluation

South Africa's department of health devoted themselves to the clinical nursing education and training model, which indorses preceptors as essential stakeholders to promote competence in students. A preceptor-training programme was developed that build on this model and implemented through an intervention. The initial programme theory hypothesised that trained preceptors would promote support and develop competence in students in comparison to untrained preceptors. Results showed a poor outcome because few preceptors participated and a high student attrition rates. The authors then posed the question "Why did the preceptorship training programme not work?" This article offers insight into the context, mechanism, and outcome of the preceptor-training programme through a realist evaluation. Reflective field notes, gathered during the intervention, were used and gave insight regarding how, for whom, and under which circumstances the programme could work and offered a refined programme theory for preceptorship. The main conclusion drawn showed that a preceptor-training programme alone is not the sole determining factor to ensure preceptors' motivation to transfer their learning; a systems approach, ensuring the effectiveness of the programme, should be followed. Reflection on findings indicated the implementation context as a major determining factor of the training programme.

Monitoring preceptors' supportive role: A measuring instrument for increased accountability

PURPOSE

This article describes the development of a measuring instrument to monitor support offered by preceptors during their accompaniment of students in clinical facilities.

DESIGN

A quantitative methodological study design was used to develop the instrument.

METHODS

Data were collected by means of a self-completed questionnaire. Total sampling of 192 undergraduate nursing students was done. Descriptive data analysis was conducted regarding the biographical characteristics, Cronbach's alpha was computed to determine the reliability, and an exploratory factor analysis was done to describe the construct validity of the developed instrument.

RESULTS

The Cronbach's alpha of 0.98 indicates high reliability and high internal consistency. Three constructs regarding clinical support, namely cognitive-, emotional- and system support were identified by means of the exploratory factor analysis.

CONCLUSION

The new conceptualisation of support gives insight into the value of the preceptor's role. The instrument designed for this study could be used to assess and monitor the support offered by preceptors while they accompany students in clinical practice.

CLINICAL RELEVANCE

Considering the need to strengthen nursing and midwifery education systems, this instrument contributes to measuring and monitoring clinical accompaniment of students by preceptors.

Wolbachia-induced transcription factor GATA4 suppresses ovary-specific genes blastoderm-specific protein 25D and imaginal disc growth factor

The endosymbiotic bacterium Wolbachia infects a wide array of insect hosts and has been implicated in a range of biological modifications as a consequence of its infection. Previously, it was shown that the transcription factor GATA4 was significantly induced in Wolbachia wMelPop-CLA strain infected Aedes aegypti whole mosquitoes and cells. Here, we provide evidence that this induction also occurs in mosquito ovaries where the ovary-specific genes blastoderm-specific protein 25D (Bsg25D) and imaginal disc growth factor (Disc) are suppressed by Wolbachia. We further demonstrate that transcriptional depletion of GATA4 results in upregulation of both genes and conversely its overexpression leads to downregulation of the genes, suggesting that Wolbachia-induced GATA4 plays a suppressive regulatory role with regards to Bsg25D and Disc expression in mosquito ovaries. When the Disc gene was silenced in mosquitoes, we did not observe any difference in the number of mature ovarian follicles developed between treatment groups. However, we did find a significant delay in the hatching of eggs that had been laid by Disc knockdown mosquitoes.

Off-site movement of endosulfan from irrigated cotton in New South Wales

The fate and transport of endosulfan (6,7,8,9,10,10-hexachloro-1,5, 5a,6,9,9a-hexahydro-6,9-methano-2,4,3-benzodioxathiepin 3-oxide) applied to cotton (Gossypium hirsutum L.) fields were studied throughout three consecutive years on two selected locations in New South Wales (Australia). Rates of dissipation from foliage and soil, volatilization from the field, and transport of residues in irrigation and/or storm runoff waters were measured in order to estimate a total field balance. Dissipation of endosulfan from both foliage and soil is best explained by a two-phase process rather than by a first-order decay. Half-lives of total endosulfan toxic residues (alpha- and beta-endosulfan and the sulfate product) in the first phase were 1.6 d in foliage and 7.1 d in soil, and could be explained by the rapid volatilization of the parent isomers in the first 5 d (up to 70% of endosulfan volatilizes). In the second phase, half-lives were 9.5 d in foliage and 82 d in soil, mostly due to the persistence of the sulfate product. Concentration of endosulfan residues in runoff water varied from 45 to 2.5 microg L(-1) depending on the residue levels present on field soil at the time of the irrigation or storm events. These in turn are related to the total amounts applied, the cotton canopy cover at application, and the time since last spraying. Most of the endosulfan in runoff was found in the water phase (80%), suggesting it was bound to colloidal matter. Total endosulfan residues in runoff for a whole season accounted for no more than 2% of the pesticide applied on-field.

[Attitude of South African dentists and final year dental students to advertising]

Advertising or promotion comprises two aspects: the advertising message and the advertising medium. Since both aspects are viewed differently by various professions, including the dental profession, the current investigation was carried out to ascertain the attitude of South African dental practitioners. Although it was found that the majority of dentists were against the advertising of new practices and re-advertising of existing practices, the majority of the final year dental students of 1986 were in favour. Both groups, however, were against unlimited advertising and also preferred professional cards to press, radio and television as the medium of communication.

Neonatal maintenance solution--is neonatalyte safe?

Newborns in the neonatal unit at Ga-Rankuwa Hospital who required intravenous fluids were randomly allocated, after 24 hours of life, to receive either Neonatalyte (Sabax) or a control solution. Biochemical monitoring was performed every 12 hours for a period of 5 days. Neonatalyte does not cause hyperkalaemia or hypocalcaemia in the early neonatal period.

[Mortality in lambs due to impaction of the abomasum by an Ornithopus sativus Brot. (seredella) bezoar]

An outbreak of mortality in a flock of Merino x Mutton Merino crossbred sheep where 62 out of 300 4 month old lambs died over a period of 3 weeks, is described. Some of the lambs showed symptoms of illthrift, but most died within a day or two as a tough phytobezoars varying in size from 15-40 mm in diameter and consisting almost exclusively of the hairs which occur on the leaves and stems of Ornithopus sativus Brot.