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

 

a.sam

 
 
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Location

 

148Reynolds BuildingCharing Cross Campus

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Summary

 

Publications

Publication Type
Year
to

93 results found

Magavern EF, Hitchings A, Bollington L, Wilson K, Hepburn D, Westacott RJ, Sam AH, Caulfield MJ, Maxwell Set al., 2024, UK Prescribing Safety Assessment (PSA): The development, implementation and outcomes of a national online prescribing assessment., Br J Clin Pharmacol, Vol: 90, Pages: 493-503

AIMS: The United Kingdom (UK) Prescribing Safety Assessment (PSA) is a 2-h online assessment of basic competence to prescribe and supervise the use of medicines. It has been undertaken by students and doctors in UK medical and foundation schools for the past decade. This study describes the academic characteristics and performance of the assessment; longitudinal performance of candidates and schools; stakeholder feedback; and surrogate markers of prescribing safety in UK healthcare practice. METHODS: We reviewed the performance data generated by over 70 000 medical students and 3700 foundation doctors who have participated in the PSA since its inception in 2013. These data were supplemented by Likert scale and free text feedback from candidates and a variety of stakeholder groups. Further data on medication incidents, collected by national reporting systems and the regulatory body, are reported, with permission. RESULTS: We demonstrate the feasibility, high quality and reliability of an online prescribing assessment, uniquely providing a measure of prescribing competence against a national standard. Over 90% of candidates pass the PSA on their first attempt, while a minority are identified for further training and assessment. The pass rate shows some variation between different institutions and between undergraduate and foundation cohorts. Most responders to a national survey agreed that the PSA is a useful instrument for assessing prescribing competence, and an independent review has recommended adding the PSA to the Medical Licensing Assessment. Surrogate markers suggest there has been improvement in prescribing safety in practice, temporally associated with the introduction of the PSA but other factors could be influential too. CONCLUSIONS: The PSA is a practical and cost-effective way of delivering a reliable national assessment of prescribing competence that has educational impact and is supported by the majority of stakeholders. There is a need to develop nati

Journal article

Brown C, Goss C, Sam S, 2023, Is the awarding gap at UK medicalschools influenced by ethnicity andmedical school attended? Aretrospective cohort study, BMJ Open, Vol: 13, ISSN: 2044-6055

Objectives: To better characterise the Awarding Gap (AG) between black and other minority ethnic (BAME) and white students in UK undergraduate medical education by examining how it affects eight minority ethnicity subgroups (Bangladeshi, black, Chinese, Indian, Pakistani, mixed, other Asian background and other ethnic background) and whether the AG varies by medical school attended.Design: Retrospective cohort study.Setting: Data extracted from the UK Medical Education Database on students enrolled at 33 UK medical schools in the academic years starting 2012, 2013 and 2014.Participants: 16,020 ‘Home’ tuition fee status students who sat the University Clinical Aptitude Test on entry to university and obtained a UK Foundation Programme Application (UKFPO) score on exit.Primary Outcome Measure: UKFPO Z-scores on exit from medical school.Results: There were significant differences in UKFPO Z-scores between ethnicity subgroups. After white students, mixed ethnicity students performed best (coefficient -0.15 standard deviations [SD] compared with white students, 95% confidence interval [CI] -0.23 to -0.08, p<0.001) and Pakistani students scored lowest (coefficient -0.53 SD, 95% CI -0.60 to -0.46, p<0.001). In pairwise comparisons of scores between all nine individual ethnicity subgroups, 15/36 were statistically significant. The AG varied considerably across medical schools. The largest gap showed the coefficient for BAME was -0.83 SD compared with white students (95% CI -1.18 to -0.49, p<0.001), while the smallest demonstrated no statistically significant difference in performance between BAME and white students (+0.05 SD, 95% CI -0.32 to 0.42, p=0.792).Conclusions: BAME students are significantly disadvantaged by the current UK medical education system. There are clear differences in medical school outcomes between students from different ethnicity subgroups, and the size of the AG also varies by medical school attended. Urgent and effective action

Journal article

Fung CY, Nichols MM, Ryan NM, Sam AHet al., 2023, TOGETHERR: a universal framework for designing teamworking teaching, Medical Education, Vol: 57, Pages: 1142-1143, ISSN: 0308-0110

Journal article

Dodd RV, Rafi D, Stackhouse AA, Brown CA, Westacott RJ, Meeran M, Hughes E, Wilkinson P, Gurnell M, Swales C, Sam SAet al., 2023, The impact of patient skin colour on diagnostic ability and confidence of medical students, Advances in Health Sciences Education, Vol: 28, Pages: 1171-1189, ISSN: 1382-4996

Previous literature has explored unconscious racial biases in clinical education and medicine, finding that people with darker skin tones can be underrepresented in learning resources and managed differently in a clinical setting. This study aimed to examine whether patient skin colour can affect the diagnostic ability and confidence of medical students, and their cognitive reasoning processes. We presented students with 12 different clinical presentations on both white skin (WS) and non-white skin (NWS). A think aloud (TA) study was conducted to explore students’ cognitive reasoning processes (n = 8). An online quiz was also conducted where students submitted a diagnosis and confidence level for each clinical presentation (n = 185). In the TA interviews, students used similar levels of information gathering and analytical reasoning for each skin type but appeared to display increased uncertainty and reduced non-analytical reasoning methods for the NWS images compared to the WS images. In the online quiz, students were significantly more likely to accurately diagnose five of the 12 clinical presentations (shingles, cellulitis, Lyme disease, eczema and meningococcal disease) on WS compared to NWS (p < 0.01). With regards to students’ confidence, they were significantly more confident diagnosing eight of the 12 clinical presentations (shingles, cellulitis, Lyme disease, eczema, meningococcal disease, urticaria, chickenpox and Kawasaki disease) on WS when compared to NWS (p < 0.01). These findings highlight the need to improve teaching resources to include a greater diversity of skin colours exhibiting clinical signs, to improve students’ knowledge and confidence, and ultimately, to avoid patients being misdiagnosed due to the colour of their skin.

Journal article

Westacott R, Badger K, Kluth D, Gurnell M, Reed M, Sam AH, Sam SAet al., 2023, Automated Item Generation: impact of item variants on performance and standard setting, BMC Medical Education, Vol: 23, ISSN: 1472-6920

BackgroundAutomated Item Generation (AIG) uses computer software to create multiple items from a single question model. There is currently a lack of data looking at whether item variants to a single question result in differences in student performance or human-derived standard setting. The purpose of this study was to use 50 Multiple Choice Questions (MCQs) as models to create four distinct tests which would be standard set and given to final year UK medical students, and then to compare the performance and standard setting data for each.MethodsPre-existing questions from the UK Medical Schools Council (MSC) Assessment Alliance item bank, created using traditional item writing techniques, were used to generate four ‘isomorphic’ 50-item MCQ tests using AIG software. Isomorphic questions use the same question template with minor alterations to test the same learning outcome. All UK medical schools were invited to deliver one of the four papers as an online formative assessment for their final year students. Each test was standard set using a modified Angoff method. Thematic analysis was conducted for item variants with high and low levels of variance in facility (for student performance) and average scores (for standard setting).ResultsTwo thousand two hundred eighteen students from 12 UK medical schools participated, with each school using one of the four papers. The average facility of the four papers ranged from 0.55–0.61, and the cut score ranged from 0.58–0.61. Twenty item models had a facility difference > 0.15 and 10 item models had a difference in standard setting of > 0.1. Variation in parameters that could alter clinical reasoning strategies had the greatest impact on item facility.ConclusionsItem facility varied to a greater extent than the standard set. This difference may relate to variants causing greater disruption of clinical reasoning strategies in novice learners compared to experts, but is c

Journal article

Hamblin R, Fountas A, Lithgow K, Loughrey PB, Bonanos E, Shinwari SK, Mitchell K, Shah S, Grixti L, Matheou M, Isand K, McLaren DS, Surya A, Ullah HZ, Klaucane K, Jayasuriya A, Bhatti S, Mavilakandy A, Ahsan M, Mathew S, Hussein Z, Jansz T, Wunna W, MacFarlane J, Ayuk J, Abraham P, Drake WM, Gurnell M, Brooke A, Baldeweg SE, Sam AH, Martin N, Higham C, Reddy N, Levy MJ, Ahluwalia R, Newell-Price J, Vamvakopoulos J, Krishnan A, Lansdown A, Murray RD, Pal A, Bradley K, Mamoojee Y, Purewal T, Panicker J, Freel EM, Hasan F, Kumar M, Jose B, Hunter SJ, Karavitaki Net al., 2023, Natural history of non-functioning pituitary microadenomas: results from the UK non-functioning pituitary adenoma consortium, EUROPEAN JOURNAL OF ENDOCRINOLOGY, Vol: 189, Pages: 87-95, ISSN: 0804-4643

Journal article

Stackhouse AA, Rafi D, Walls R, Dodd RV, Badger K, Davies DJ, Brown C, Cowell A, Meeran K, Halse O, Kinross J, Lupton M, Hughes E, Sam SAet al., 2023, Knowledge attainment and engagement among medical students: a comparison of three forms of online learning, Advances in Medical Education and Practice, Vol: 14, Pages: 373-380, ISSN: 1179-7258

Objective: This study compared knowledge attainment and student enjoyment and engagement between clinical case vignette, patient-testimony videos and mixed reality (MR) teaching via the Microsoft HoloLens 2, all delivered remotely to third year medical students. The feasibility of conducting MR teaching on a large scale was also assessed.Setting & Participants: Medical students in Year 3 at Imperial College London participated in three online teaching sessions, one in each format. All students were expected to attend these scheduled teaching sessions and to complete the formative assessment. Inclusion of their data used as part of the research trial was optional.Primary and Secondary Outcome Measures: The primary outcome measure was performance on a formative assessment, which served to compare knowledge attainment between three forms of online learning. Moreover, we aimed to explore student engagement with each form of learning via a questionnaire, and also feasibility of applying MR as a teaching tool on a large scale. Comparisons between performances on the formative assessment between the three groups were investigated using a repeated measures two-way ANOVA. Engagement and enjoyment were also analysed in the same manner.Results: A total of 252 students participated in the study. Knowledge attainment of students using MR was comparable with the other two methods. Participants reported higher enjoyment and engagement (p< 0.001) for the case vignette method, compared with MR and video-based teaching. There was no difference in enjoyment or engagement ratings between MR and the video-based methods.Conclusion: This study demonstrated that the implementation of MR is an effective, acceptable, and feasible way of teaching clinical medicine to undergraduate students on a large scale. However, case-based tutorials were found to be favoured most by students. Future work could further explore the best uses for MR teaching within the medical curriculum.

Journal article

Bala L, Westacott RJ, Brown C, Sam AHet al., 2023, Twelve tips for introducing very short answer questions (VSAQs) into your medical curriculum, MEDICAL TEACHER, Vol: 45, Pages: 360-367, ISSN: 0142-159X

Journal article

Sam AHH, Lam G, Amin A, 2023, Medical exams in the era of accessible artificial intelligence, MEDICAL TEACHER, ISSN: 0142-159X

Journal article

Hejri SMH, Ho JL, Pan X, Park YS, Sam AH, Mangardich H, MacIntosh Aet al., 2023, Validity of constructed-response situational judgment tests in training programs for the health professions: A systematic review and meta-analysis protocol, PLOS ONE, Vol: 18, ISSN: 1932-6203

Journal article

Fung CY, Kearney L, Hatfield E, Martin NM, Halse O, Jensen-Martin J, Hughes E, Sam AHet al., 2022, Effectiveness of short, personalised student assistantships: an evaluative study across eight London hospitals, BMJ Open, Vol: 12, ISSN: 2044-6055

Objectives: Student assistantships are recommended to prepare medical graduates for clinical practice. Traditionally, assistantships have consisted of longer placements, often up to 15 weeks. However, within the constraints of the final year, medical schools need to carefully balance the time required for specialty placements, assessments and the risk of student burnout. We set out to evaluate the effectiveness of shorter, personalised student assistantships.Design: An evaluative study on the changes in final year student confidence in preparedness for practice after a 3-week assistantship with defined learning objectives and learning needs assessment.Setting: Eight hospitals affiliated with Imperial College School of Medicine.Outcomes: Student confidence in 10 learning outcomes including organising ward rounds, documentation, communication with colleagues, communication with patients and relatives, patient handover, practical procedures, patient management, acute care, prioritisation and out-of-hours clinical work.Results: Two hundred and twenty final year medical students took part in the student assistantship, of whom 208 completed both the pre-assistantship and post-assistantship confidence rating questionnaires (95% completion rate). After the assistantship, 169 (81%) students expressed increased confidence levels in one or more learning objectives. For each individual learning objective, there was a significant change in the proportion of students who agreed or strongly agreed after the assistantship (p<0.0001).Conclusion: Overall, the focused 3-week, personalised student assistantships led to significant improvement across all learning objectives related to preparedness for practice. The use of the pre-assistantship confidence rating questionnaire allowed students to identify and target areas of learning needs during their assistantship.

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

Sam AH, Fung CY, Reed M, Hughes E, Meeran Ket al., 2022, Time for preference-informed foundation allocation?, Clinical medicine (London, England), Vol: 22, Pages: 590-593, ISSN: 1470-2118

Successful completion of year 1 of the UK Foundation Programme is a General Medical Council requirement that newly qualified doctors must achieve in order to gain full registration for licence to practise in the UK. We present compelling evidence that both sections of the UK Foundation Programme allocation process, consisting of the Educational Performance Measure and Situational Judgement Test scores, are not fit for purpose. The ranking process drives competitive behaviours among medical students and undermines NHS teamworking values. Furthermore, data from 2013-2020 show that UK minority ethnic students consistently receive significantly lower SJT scores than White students. The current process in the UK allocates lower ranked students, who often need more academic and social support, to undersubscribed regions. This can lead to vacancies in less popular regions, ultimately worsening health inequality. A preference-informed allocation process will improve trainee access to support and help retain trainees in underserved regions. We aim to summarise the flaws of the current system and report a potential radical solution.

Journal article

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

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

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

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., 2022, 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

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

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

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

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

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

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

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

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

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

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