1. Updates for Medicine & Surgery Exams in Year 5 Curriculum Retreat 2007 Comparing Outcomes from New and Old Curricula 8 September 2007 Paul B. S. Lai HBP Surgery, CUHK

2. Med 5 Exam: students from old curriculum vs. first batch of new curriculum graduates vs. second batch of new curriculum graduates

3. Exam format for med 5 Medicine

4. Final MB examination in Medicine History Short case 1Short case 2

5. Format Three sessions of 20 minutes A: History (in Cantonese) B: Short case I –CNS –CVS –Endo OR Joints OR ECG OR CT/MRI C: Short case II –Abdo –RS –Fundi OR Skin OR X-ray/CT scan

6. Clinical scoreWritten score 2005-200654.3%54.1% 2006-200753.7%55.7% P = 0.043P < 0.001 Comparison of Scores in Medicine (Class 2006 vs. 2007)

7. Exam format for med 5 Surgery

8. Change in Final Surgery Exam 2005/2006 Written papers -paper 1 (MCQs) [4 hrs] -paper 2 (R-type MCQs + MEQs) [3 hrs] OSCE –2 hrs & 10 mins for 21 effective stations and 5 rest stations –total 21 stations and 20 of them carrying marks 2006/2007 Written (50%) & OSCE (50%) –paper 1 (MCQs) [3 hrs] –paper 2 (R-type MCQs + MEQs) [3 hrs] –OSCE [1 hrs & 35 mins for 13 effective stations and 3 rest stations] Clinical examination –Two pairs of examiners, 20 minutes each (i.e. total of 40 minutes of short to intermediate cases) Since examination format changed, cannot compare performance by their marks like last year.

9. Exam results for med 5 Medicine & Surgery

10. If we use the ranking in the class to correlate, the R-Square was 0.32 (but still significant). [Pearson correlation of 0.57 if we use simple correlation for ranking in the class]

11. If we use numerical marks in the class to correlate, the R-Square was 0.428 (P <0.001)

12. Surgery (written + OSCE) Surgery (clinical exam) Surgery class rank Candidate no. Medicine class rank Medicine (combined written and clinical) Remarks for medicine 47.24%30.0%1495614848.84%Fail in medicine 42.41%35.0%14810415045.00%Fail in medicine 51.39%25.0%15011714450.58%Pass in Medicine 51.82%40.0%14712413651.86%Pass in Medicine Students Failing Surgery (Class 2006-2007)

13. Medicine (combined written and clinical) Medicine class rank Candidate no. Surgery (written + OSCE) Surgery (clinical exam) Surgery class rank Remarks for surgery 48.85%1485647.24%30%149Failed in surgery too 49.16%1476852.57%50%143Pass in surgery 47.74%1497850.89%55%136Pass in surgery 45.00%15010442.41%35%148Failed in surgery too 49.81%14613257.62%45%142Pass in surgery 50.67%14313464.45%60%78Pass in surgery Students Failing Medicine (Class 2006-2007)

14. Possible Explanations Both medicine and surgery in the final years call for a lot of clinical skills, knowledge of clinical management, as well as basic scientific knowledge Examination formats are very similar – written (MCQs, R- type, MEQs), OSCE, clinical examination, etc. For those students who were weak in years 1-4 years, they would not have time to catch up as year 5 would be a very tight year for this group of students

15. The basic message of these two slides is that med 5 students tend to do well (and do badly as well) in both medicine and surgery at the same time. This pattern was also observed in the previous year (2005/06 class – the first batch of graduates from the new curriculum). I wish to illustrate one point by these two slides on correlations between medicine and surgery – both examinations were heavily clinical-based and students who are good and competent in their generic clinical skills and were more likely to pass through the examination

16. Exam results for med 5 Does it matter where the students came from?

17. Combined Grades of Medicine & Surgery (Class 2006-2007) Total no. of students Group A (good performance) Group B (average performance) Group C (bad performance) JUPAS10016 (16%)69 (69%)15 (15%) Non-JUPAS151 (7%)8 (53%)6 (40%) EAS279 (33%)17 (63%)1 (4%) Internal Transfer 1010

18. Bench Marking 11 vignette-based high quality reasoning MCQ items from Britain (1), Canada (5), Australia(4) & UAE (1) were included in the Medicine’s final assessment in 2007 average performance of CUHK was 4.4% higher than the average performances of students in these respective centres limitation: number of items is small, particularly in reference to the number of schools included in this benchmarking exercise

19. End of day 4 (pull-up and distinction viva) – all the external examiners were shattered

20. Examiners in Medicine had a good time