Neurology Exit Examination System in India: A Survey of Examiners' Perceptions and Recommendations

Background

The traditional Neurology exit examination in India has remained unchanged over the last few decades. In developed countries, objective evaluation methods have replaced the traditional ones. A need for such methods has not been explored in India.

Objective

We aimed to study the perceptions and key recommendations of Neurology examiners on the existing examination pattern.

Material and Methods

We conducted an online survey of examiners perceptions and recommendations using a set of 10 multiple-choice questions and an open-ended question.

Results

46 examiners provided completed responses suitable for analysis. Nearly equal proportions (30%) of the examiners had 10 years, 10-25 years and >25 years' experience. 92% were not satisfied with current system, 95% did not find adequate time for correction of theory scripts, 90% felt that theory questions were random, and 95% had legibility issues. 84% felt that the practical exams do not test true learning, 98% felt the examination stress impairs the performance and 85% felt that there are no objective criteria to pass the candidate. 83% felt the current system-needed changes. The key suggestions provided by the examiners to improve the system included objective assessments like MCQ, OSCE, OSLER and DOPS, inclusion of larger number of short answer type questions and periodic internal assessments of the candidates.

Conclusions

A vast majority of examiners favoured changes to the current examination system and provided key recommendations. A larger study is needed to extrapolate these findings to the rest of India.

Inter-Rater Reliability Of Objective Structured Long Examination Record

BACKGROUND

Objective Structured Long Examination Record (OSLER) scale was introduced in 1997 by Gleeson to improve the long case examination. There is no psychometric evidence to support reliability of OSLER. This study was done to analyse inter-rater reliability of OSLER.

METHODS

Two groups of examiners assessed 105 students in long case examination of their final professional examination, using OSLER scale. Group 1 was composed of actual examiners while Group 2 was mock examiners. Kappa statistic and intraclass correlation coefficient (ICC) were used on SPSS 23 to calculate reliability.

RESULTS

Mean score awarded by actual examiners was 55.36 (SD=11.2) whereas mean score by mock examiners was 57.74 (SD=14.1). Cronbach's alpha was 0.586, Kappa was 0.019 whereas inter-rater reliability on ICC was 0.413.

CONCLUSIONS

Although OSLER is a practical modification of long case examination with good validity, the scale needs to be more structured to improve its reliability.

Low High-Density Lipoprotein and Risk of Myocardial Infarction

Low HDL is an independent risk factor for myocardial infarction. This paper reviews our current understanding of HDL, HDL structure and function, HDL subclasses, the relationship of low HDL with myocardial infarction, HDL targeted therapy, and clinical trials and studies. Furthermore potential new agents, such as alirocumab (praluent) and evolocumab (repatha) are discussed.