Imperial College London

Professor Amir H Sam

Faculty of MedicineFaculty of Medicine Centre

Head of Imperial College School of Medicine, Professor
 
 
 
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Contact

 

+44 (0)20 7594 9807a.sam

 
 
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Location

 

148Reynolds BuildingCharing Cross Campus

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Summary

 

Publications

Publication Type
Year
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81 results found

McGown PJ, Brown CA, Sebastian A, Le R, Amin A, Greenland A, Sam SAet al., 2022, Is the assumption of equal distances between global assessment categories used in borderline regression valid?, BMC Medical Education, ISSN: 1472-6920

Journal article

Sam SA, Millar K, Westacott R, Melville CR, Brown CAet al., 2022, Standard setting Very Short Answer Questions (VSAQs) relative to Single Best Answer Questions (SBAQs): does having access to the answers make a difference?, BMC Medical Education, Vol: 22, ISSN: 1472-6920

BackgroundWe investigated whether question format and access to the correct answers affect the pass mark set by standard-setters on written examinations. MethodsTrained educators used the Angoff method to standard set two 50-item tests with identical vignettes, one in a single best answer question (SBAQ) format (with five answer options) and the other in a very short answer question (VSAQ) format (requiring free text responses). Half the participants had access to the correct answers and half did not. The data for each group were analysed to determine if the question format or having access to the answers affected the pass mark set.ResultsA lower pass mark was set for the VSAQ test than the SBAQ test by the standard setters who had access to the answers (median difference of 13.85 percentage points, Z=-2.82, p=0.002). Comparable pass marks were set for the SBAQ test by standard setters with and without access to the correct answers (60.65% and 60.90% respectively). A lower pass mark was set for the VSAQ test when participants had access to the correct answers (difference in medians -13.75 percentage points, Z=2.46, p=0.014). ConclusionsWhen given access to the potential correct answers, standard setters appear to appreciate the increased difficulty of VSAQs compared to SBAQs.

Journal article

Bala L, Westacott RJ, Brown C, Sam AHet al., 2022, Twelve tips for introducing very short answer questions (VSAQs) into your medical curriculum, MEDICAL TEACHER, ISSN: 0142-159X

Journal article

Brown CA, Badger K, Reid MD, Westacott R, Gurnell M, Reed MWR, Chamberlain G, Hatfield E, Sharif A, Sam AHet al., 2022, The influence of candidates' physical attributes on patient ratings in simulated assessments of clinical practice, MEDICAL TEACHER, Vol: 44, Pages: 1277-1282, ISSN: 0142-159X

Journal article

Davies DJ, Sam AH, Murphy KG, Khan SA, Choe R, Cleland Jet al., 2022, BMAT's predictive validity for medical school performance: A retrospective cohort study, MEDICAL EDUCATION, Vol: 56, Pages: 936-948, ISSN: 0308-0110

Journal article

Misky A, Shah R, Meeran K, Kingsbury M, Sam A, Salem Vet al., 2022, Understanding concepts of generalism and specialism amongst medical students at a research-intensive London Medical School, BMC Medical Education, Vol: 22, Pages: 1-11, ISSN: 1472-6920

BackgroundMany prominent UK medical organisations have identified a need for more generalist clinicians to address the complex requirements of an aging society. We sought to clarify attitudes towards “Specialists” and “Generalists” amongst medical students and junior doctors at Imperial College School of Medicine.MethodsA survey exploring medical students’ beliefs was followed up by qualitative analysis of focus groups of medical students and Imperial-graduate foundation year doctors.ResultsFirst year medical students associated specialists with academia and higher income, and generalists with ease of training and job availability. Senior (Years 5/6) medical students associated specialists even more firmly with broader influence and academic work, whilst generalists were assigned lower prestige but the same workload as specialists. The medicalstudent focus group discussed concepts of Generalism pertaining only to Primary Care. In contrast, the foundation year doctor focus group revealed that Generalism was now seen to include some hospital care, and the perception that generalists sat lower in a knowledge hierarchy had been challenged.ConclusionPerceptions that Generalism is associated with lower prestige in the medical profession are already present at the very start of medical school and seem to be reinforced during undergraduate training. In early postgraduate clinical practice, the perceived knowledge and prestige hierarchy lessens. These findings can help inform curriculum redesign and the promotion of Generalism as a rewarding career aspiration.

Journal article

Davies DJ, McLean PF, Kemp PR, Liddle AD, Morrell MJ, Halse O, Martin NM, Sam AHet al., 2022, Assessment of factual recall and higher-order cognitive domains in an open-book medical school examination, Advances in Health Sciences Education, Vol: 27, Pages: 147-165, ISSN: 1382-4996

Open-book examinations (OBEs) will likely become increasingly important assessment tools. We investigated how access to open-book resources affected questions testing factual recall, which might be easy to look-up, versus questions testing higher-order cognitive domains. Few studies have investigated OBEs using modern Internet resources or as summative assessments. We compared performance on an examination conducted as a traditional closed-book exam (CBE) in 2019 (N = 320) and a remote OBE with free access to Internet resources in 2020 (N = 337) due to COVID-19. This summative, end-of-year assessment focused on basic science for second-year medical students. We categorized questions by Bloom’s taxonomy (‘Remember’, versus ‘Understand/Apply’). We predicted higher performance on the OBE, driven by higher performance on ‘Remember’ questions. We used an item-centric analysis by using performance per item over all examinees as the outcome variable in logistic regression, with terms ‘Open-Book, ‘Bloom Category’ and their interaction. Performance was higher on OBE questions than CBE questions (OR 2.2, 95% CI: 2.14–2.39), and higher on ‘Remember’ than ‘Understand/Apply’ questions (OR 1.13, 95% CI: 1.09–1.19). The difference in performance between ‘Remember’ and ‘Understand/Apply’ questions was greater in the OBE than the CBE (‘Open-Book’ * ‘Bloom Category’ interaction: OR 1.2, 95% CI: 1.19–1.37). Access to open-book resources had a greater effect on performance on factual recall questions than higher-order questions, though performance was higher in the OBE overall. OBE design must consider how searching for information affects performance, particularly on questions measuring different domains of knowledge.

Journal article

Putt O, Westacott R, Sam AH, Gurnell M, Brown CAet al., 2022, Using very short answer errors to guide teaching, CLINICAL TEACHER, Vol: 19, Pages: 100-105, ISSN: 1743-4971

Journal article

Goss C, Culley FJ, Parthasarathy P, MacLeod K, McGregor AH, Sam AHet al., 2022, A paragigm shift in assessment of scientific skills in undergraduate medical education, Advances in Medical Education and Practice, Vol: 13, Pages: 123-127, ISSN: 1179-7258

The General Medical Council’s publication ‘Outcomes for Graduates’ places emphasis on doctors being able to integrate biomedical science, research and scholarship with clinical practice. In response, a new paradigm of assessment was introduced for the intercalated Bachelor of Science program at Imperial College School of Medicine in 2019. This innovative approach involves authentic “active learning” assessments analogous to tasks encountered in a research environment and intends to test a wider range of applied scientific skills than traditional examinations. Written assessments include a “Letter to the Editor”, scientific abstract, and production of a lay summary. A clinical case study titled “Science in Context” presents a real or virtual patient, with evaluation of current and emerging evidence within that field. Another assessment emulates the academic publishing process: groups submit a literature review and engage in reciprocal peer review of another group’s work. A rebuttal letter accompanies the final submission, detailing how feedback was addressed. Scientific presentation skills are developed through tasks including a research proposal pitch, discussion of therapies or diagnostics, or review of a paper. A data management assignment develops skills in hypothesis generation, performing analysis, and drawing conclusions. Finally, students conduct an original research project which is assessed via a written report in the format of a research paper and an oral presentation involving critical analysis of their project. We aspire to train clinicians who apply scientific principles to critique the evidence base of medical practice and possess the skillset to conduct high-quality research underpinned by the principles of best clinical and academic practice. Assessment drives learning, and active learning has been demonstrated to enhance academic performance and reduce attainment gaps in science education.

Journal article

Bala L, Pedder S, Sam AH, Brown Cet al., 2021, Assessing the predictive validity of the UCAT—A systematic review and narrative synthesis, Medical Teacher, Vol: 44, Pages: 401-409, ISSN: 0142-159X

BackgroundThe University Clinical Aptitude Test (UCAT) is an admissions assessment used by a consortium of universities across the UK, Australia, and New Zealand, to aid the selection of applicants to medical and dental degree programmes. The UCAT aims to measure the mental aptitude and professional behaviours required to become successful doctors and dentists. We conducted a systematic review to establish the predictive value of the UCAT across measures of performance at undergraduate and post-graduate levels.MethodsA literature search was conducted in April 2020 using eight electronic databases: MEDLINE, APA PsycInfo, SCOPUS, Web of Science, EThOS, OpenGrey, PROSPERO, and the UCAT website. Data were extracted from selected studies and tabulated as results matrices. A narrative synthesis was performed.ResultsTwenty-four studies satisfied our inclusion criteria, 23 of which were deemed to be of good quality (using the Newcastle-Ottawa Scale). For over 70% of univariate data points, the UCAT exerted no statistically significant predictive validity; for the remainder, predictive power was weak. The cognitive total and verbal reasoning subtests had the largest evidence base as weakly positive predictors of academic performance. The SJT subtest was a weak predictor of professional behaviour during medical school. Studies specific to dental schools demonstrated variable findings across the five studies. Only 1 study looked at post-graduate outcome measures and demonstrated that the UCAT was not a predictor of health- or conduct-related fitness to practice declarations at GMC registration.ConclusionsThese data provide some support for the use of cognitive total and verbal reasoning subtests as part of medical school selection. Further research is needed to investigate outcomes beyond professional registration and for dental students.

Journal article

Rafi D, Stackhouse AA, Walls R, Dani M, Cowell A, Hughes E, Sam AHet al., 2021, A new reality: Bedside geriatric teaching in an age of remote learning., Future Healthc J, Vol: 8, Pages: e714-e716, ISSN: 2514-6645

Population ageing poses many challenges in the landscape of general medicine. One of these is the requirement for more geriatricians to minimise future strain on healthcare systems. Previous studies have identified that, while demand for geriatricians is on the rise, interest among medical students for a career in geriatrics falls behind. We utilised a new augmented reality technology (the Microsoft HoloLens 2) to deliver students a remote bedside teaching experience. Features of this teaching included bi-directional communication, exposure to physical signs, and use of holograms around the patient bedside as a teaching aid. Given its convenience, scope and engagement potential, this educational tool has potential to be used effectively throughout medical training.

Journal article

Sam AH, Bala L, Westacott RJ, Brown Cet al., 2021, Is academic attainment or situational judgment test performance in medical school associated with the likelihood of disciplinary action? a national retrospective cohort study, Academic Medicine, Vol: 96, Pages: 1467-1475, ISSN: 1040-2446

Purpose Disciplinary action imposed on physicians indicates their fitness to practice medicine is impaired and patient safety is potentially at risk. This national retrospective cohort study sought to examine whether there was an association between academic attainment or performance on a situational judgment test (SJT) in medical school and the risk of receiving disciplinary action within the first 5 years of professional practice in the United Kingdom.Method The authors included data from the UK Medical Education Database for 34,865 physicians from 33 U.K. medical schools that started the UK Foundation Programme (similar to internship) between 2014 and 2018. They analyzed data from 2 undergraduate medical assessments used in the United Kingdom: the Educational Performance Measure (EPM), which is based on academic attainment, and SJT, which is an assessment of professional attributes. The authors calculated hazard ratios (HRs) for EPM and SJT scores.Results The overall rate of disciplinary action was low (65/34,865, 0.19%) and the mean time to discipline was 810 days (standard deviation [SD] = 440). None of the physicians with fitness to practice concerns identified as students went on to receive disciplinary action after they qualified as physicians. The multivariate survival analysis demonstrated that a score increase of 1 SD (approximately 7.6 percentage points) on the EPM reduced the hazard of disciplinary action by approximately 50% (HR = 0.51; 95% confidence interval [CI]: 0.38, 0.69; P < .001). There was not a statistically significant association between the SJT score and the hazard of disciplinary action (HR = 0.84; 95% CI: 0.62, 1.13; P = .24).Conclusions An increase in EPM score was significantly associated with a reduced hazard of disciplinary action, whereas performance on the SJT was not. Early identification of increased risk of disciplinary action may provide an opportunity for remediation and avoidance of patient harm.

Journal article

Sam AH, Fung CY, Barth J, Raupach Tet al., 2021, A weighted evaluation study of clinical teacher performance at five hospitals in the UK, Advances in Medical Education and Practice, Vol: 2021, Pages: 957-963, ISSN: 1179-7258

Introduction: Evaluation of individual teachers in undergraduate medical education helps clinical teaching fellows identify their own strengths and weaknesses; in addition, evaluation data can be used to guide career decisions. In order for evaluation results to adequately reflect true teaching performance, a range of parameters should be considered when designing data collection tools.Methods: Clinical teaching fellows at five London teaching hospitals were evaluated by third-year students they had supervised during a ten-week clinical attachment. The questionnaire addressed (1) general teaching skills and (2) student learning outcomes measured via comparative self-assessments. Teachers were ranked using different algorithms with various weights assigned to these two factors.Results: A total of 133 students evaluated 14 teaching fellows. Overall, ratings on teaching skills were largely favourable while the perceived increase in student performance was modest. Considerable variability across teachers was observed for both factors. Teacher rankings were strongly influenced by the weighting algorithm used. Depending on the algorithm, one teacher was assigned any rank between #2 and #10.Conclusions: Both parts of the questionnaire address different outcomes and thus highlight specific strengths and weaknesses of individual teachers. Programme directors need to carefully consider the weight assigned to individual components of teacher evaluations so as to ensure a fair appraisal of teacher performance.

Journal article

Tekkis NP, Rafi D, Brown S, Courtney A, Kawka M, Howell A-M, McLean K, Gardiner M, Mavroveli S, Hutchinson P, Tekkis P, Wilkinson P, Sam AH, Savva N, Kontovounisios Cet al., 2021, The impact of the COVID-19 pandemic on UK medical education. A nationwide student survey, MEDICAL TEACHER, Vol: 44, Pages: 574-575, ISSN: 0142-159X

Journal article

Bala L, Kinross J, Martin G, Koizia LJ, Kooner AS, Shimshon GJ, Hurkxkens TJ, Pratt PJ, Sam AHet al., 2021, A remote access mixed reality teaching ward round, The Clinical Teacher, Vol: 18, Pages: 386-390, ISSN: 1743-4971

BackgroundHeterogeneous access to clinical learning opportunities and inconsistency in teaching is a common source of dissatisfaction among medical students. This was exacerbated during the COVID‐19 pandemic, with limited exposure to patients for clinical teaching.MethodsWe conducted a proof‐of‐concept study at a London teaching hospital using mixed reality (MR) technology (HoloLens2™) to deliver a remote access teaching ward round.ResultsStudents unanimously agreed that use of this technology was enjoyable and provided teaching that was otherwise inaccessible. The majority of participants gave positive feedback on the MR (holographic) content used (n = 8 out of 11) and agreed they could interact with and have their questions answered by the clinician leading the ward round (n = 9). Quantitative and free text feedback from students, patients and faculty members demonstrated that this is a feasible, acceptable and effective method for delivery of clinical education.DiscussionWe have used this technology in a novel way to transform the delivery of medical education and enable consistent access to high‐quality teaching. This can now be integrated across the curriculum and will include remote access to specialist clinics and surgery. A library of bespoke MR educational resources will be created for future generations of medical students and doctors to use on an international scale.

Journal article

Sam AH, Wilson R, Westacott R, Gurnell M, Melville C, Brown CAet al., 2021, Thinking differently - Students' cognitive processes when answering two different formats of written question, MEDICAL TEACHER, Vol: 43, Pages: 1278-1285, ISSN: 0142-159X

Journal article

Zaman S, Almazrouei R, Sam AH, DiMarco AN, Todd JF, Palazzo FF, Tan T, Dhillo WS, Meeran K, Wernig Fet al., 2021, Synacthen stimulation test following unilateral adrenalectomy needs to be interpreted with caution, Frontiers in Endocrinology, Vol: 12, Pages: 1-7, ISSN: 1664-2392

Background: Cortisol levels in response to stress are highly variable. Baseline and stimulated cortisol levels are commonly used to determine adrenal function following unilateral adrenalectomy. We report the results of synacthen stimulation testing following unilateral adrenalectomy in a tertiary referral center.Methods: Data were collected retrospectively for 36 patients who underwent synacthen stimulation testing one day post unilateral adrenalectomy. None of the patients had clinical signs of hypercortisolism preoperatively. No patient received pre- or intraoperative steroids. Patients with overt Cushing’s syndrome were excluded.Results: The median age was 58 (31-79) years. Preoperatively, 16 (44%) patients had a diagnosis of pheochromocytoma, 12 (33%) patients had primary aldosteronism and 8 (22%) patients had non-functioning adenomas with indeterminate/atypical imaging characteristics necessitating surgery. Preoperative overnight dexamethasone suppression test results revealed that 6 of 29 patients failed to suppress cortisol to <50 nmol/L. Twenty (56%) patients achieved a stimulated cortisol ≥450 nmol/L at 30 minutes and 28 (78%) at 60 minutes. None of the patients developed clinical adrenal insufficiency necessitating steroid replacement.Conclusions: Synacthen stimulation testing following unilateral adrenalectomy using standard stimulated cortisol cut-off values would wrongly label many patients adrenally insufficient and may lead to inappropriate prescriptions of steroids to patients who do not need them.

Journal article

Millar KR, Reid MD, Rajalingam P, Canning CA, Halse O, Low-Beer N, Sam AHet al., 2021, Exploring the feasibility of using very short answer questions (VSAQs) in team-based learning (TBL), CLINICAL TEACHER, Vol: 18, Pages: 404-408, ISSN: 1743-4971

Journal article

Bala L, Wynn-Lawrence LS, Sam AH, 2021, Supplementation: an improved approach to question-based collaborative learning [response to letter], Advances in Medical Education and Practice, Vol: 12, Pages: 251-252, ISSN: 1179-7258

Journal article

Bogomolova K, Sam AH, Misky AT, Gupte CM, Strutton PH, Hurkxkens TJ, Hierck BPet al., 2021, Development of a virtual three-dimensional assessment scenario for anatomical education, Anatomical Sciences Education, Vol: 14, Pages: 385-393, ISSN: 1935-9772

In anatomical education three-dimensional (3D) visualization technology allows for active and stereoscopic exploration of anatomy and can easily be adopted into medical curricula along with traditional 3D teaching methods. However, most often knowledge is still assessed with two-dimensional (2D) paper-and-pencil tests. To address the growing misalignment between learning and assessment, this viewpoint commentary highlights the development of a virtual 3D assessment scenario and perspectives from students and teachers on the use of this assessment tool: a 10-minute session of anatomical knowledge assessment with real-time interaction between assessor and examinee, both wearing a HoloLens and sharing the same stereoscopic 3D augmented reality model. Additionally, recommendations for future directions, including implementation, validation, logistic challenges, and cost-effectiveness, are provided. Continued collaboration between developers, researchers, teachers, and students is critical to advancing these processes.

Journal article

Sam AH, Reid MD, Thakerar V, Gurnell M, Westacott R, Yeates P, Reed MWR, Brown CAet al., 2021, The influence of candidates' physical attributes on assessors' ratings in clinical practice, MEDICAL TEACHER, Vol: 43, Pages: 554-559, ISSN: 0142-159X

Journal article

Wynn-Lawrence LS, Bala L, Fletcher RJ, Wilson RK, Sam AHet al., 2021, Question-based collaborative learning for constructive curricular alignment, Advances in Medical Education and Practice, Vol: 2020, Pages: 1047-1053, ISSN: 1179-7258

IntroductionWe designed a curriculum mapping tool which enables medical students to access intended learning outcomes (ILOs) on their iPads in the workplace. Students were encouraged to use the online curriculum map in a specially planned teaching session: Question-Based Collaborative Learning (QBCL). The aim of the session was to empower medical students to constructively align their experiential learning with the learning outcomes of the undergraduate curriculum. In doing so, our session aimed to provide students with a greater understanding of the curriculum, improve their insights into assessment and their question-writing abilities. MethodsThe QBCL pre-session preparation involved reviewing a patient with a presentation that aligned to the year-specific ILOs. During a 150 minute QBCL session, students received training on how to write high quality multiple choice questions (MCQs) delivered by a faculty member of Imperial College School of Medicine. They then worked collaboratively in groups and created MCQs based on their clinical encounters. Their questions were tagged to the relevant learning objective and submitted online via the curriculum map. The student-generated MCQs were analyzed using an adjusted version of Bloom’s taxonomy. We also conducted a quantitative evaluation of the session.ResultsOne hundred and sixty-three questions were submitted, with 81% of questions being tagged to ILOs considered to show evidence of learning consistent with the ‘Apply’ tier of Bloom’s taxonomy. The majority of students agreed that the session was interactive (80%), thought-provoking (77%) and improved their team-working skills (70%). It gave them a greater understanding of the undergraduate curriculum (65%), improved their question-writing and insight into assessments (76%), and provided an opportunity to learn from their peers (86%). Students agreed that this session covered a variety of cases (82%) and deepened their understanding of medical c

Journal article

Karunaratne D, Karunaratne N, Wilmot J, Vincent T, Wright J, Mahmood N, Tang A, Sam AH, Reed M, Howlett Det al., 2021, An Online Teaching Resource to Support UK Medical Student Education During the COVID-19 Pandemic: A Descriptive Account, ADVANCES IN MEDICAL EDUCATION AND PRACTICE, Vol: 12, Pages: 1317-1327, ISSN: 1179-7258

Journal article

Sam AH, Millar KR, Lupton MGF, 2021, In Reply to Guragai, Academic Medicine, Pages: E1-E2, ISSN: 1040-2446

Journal article

Sam AH, Millar KR, Lupton MGF, 2021, "Digital Clinical Placements": Challenges in a Lower Middle-Income Country Reply, ACADEMIC MEDICINE, Vol: 96, Pages: E1-E2, ISSN: 1040-2446

Journal article

Fung CY, Tan ZM, Savage A, Rahim M, Osman F, Adnan M, Peleva E, Sam AHet al., 2020, Undergraduate exposure to patient presentations on the acute medical placement: a prospective study in a London teaching hospital., BMJ Open, Vol: 10, Pages: 1-5, ISSN: 2044-6055

OBJECTIVES: To identify the availability and variability of learning opportunities through patient presentations on an acute medical placement at a teaching hospital. DESIGN: A prospective study evaluating all acute admissions to the Acute Medical Unit over 14 days (336 hours). Clinical presentations and the day and time of admission were recorded and compared with the learning outcomes specified in the medical school curriculum. SETTING: An Acute Medical Unit at a London teaching hospital. OUTCOMES: (1) Number of clinical presentations to the Acute Medical Unit over 14 days and (2) differences between the availability and variation of admissions and presentations between in-hours and out-of-hours. RESULTS: There were 359 admissions, representing 1318 presentations. Of those presentations, 76.6% were admitted out-of-hours and 23.4% in-hours. Gastrointestinal bleeding, tachycardia, oedema and raised inflammatory markers were over three times more common per hour out-of-hours than in-hours. Hypoxia was only seen out-of-hours. Important clinical presentations in the curriculum such as chest pain and hemiparesis were not commonly seen. CONCLUSIONS: There is greater availability of presentations seen out-of-hours and a changing landscape of presentations seen in-hours. The out-of-hours presentation profile may be due to expanded community and specialist services. Medical schools need to carefully consider the timing and location of their clinical placements to maximise undergraduate learning opportunities.

Journal article

Sam AH, Reid MD, Thakerar V, Gurnell M, Westacott R, Reed MWR, Brown CAet al., 2020, National inter-rater agreement of standardised simulated-patient-based assessments, MEDICAL TEACHER, Vol: 43, Pages: 341-346, ISSN: 0142-159X

Journal article

Reid MD, Sam AH, 2020, Reflections on assessment in the wake of change from the COVID-19 pandemic, MEDICAL EDUCATION, Vol: 55, Pages: 128-130, ISSN: 0308-0110

Journal article

Sam AH, Millar KR, Lupton MGF, 2020, Digital Clinical Placement for Medical Students in Response to COVID-19, ACADEMIC MEDICINE, Vol: 95, Pages: 1126-1126, ISSN: 1040-2446

Journal article

Sam AH, Reid MD, Amin A, 2020, High-stakes remote-access open-book examinations, Medical Education, Vol: 54, Pages: 767-768, ISSN: 0308-0110

The COVID-19 pandemic has led to unprecedented challenges in medical school assessments. Final year high-stakes assessments have classically used closed book examinations (CBEs). Alternative methods of assessment such as open book examinations (OBEs) are emerging but are not routinely used in final year medical school exams. OBEs encourage the use of problem-solving skills more akin to those used in real-life. There is currently limited data comparing OBEs with CBEs. A systematic review showed there was insufficient evidence to support the exclusive use of either CBEs or OBEs in assessment, however the studies conducted to date have rarely looked at high-stakes assessments due to concerns about the validity of OBEs1 .

Journal article

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