Impact of extremeenvironmental eventson assessmentIan Wilson, Graduate School of Medicine, University of Wollongong, New South Wales,Australia

Wilkinson TJ, Ali AN, Bell CJ, Carter FA,

Frampton CM, McKenzie JM. The impact of

learning environment disruption on

medical student performance. Med Educ

2013;47:210–213.

As educators, events may occurthat enable us to investigateeducational impacts that wewould not be able to research inthe normal course of events.Such a series of events recentlyoccurred in Christchurch, NewZealand. Towards the end of anacademic year a large earthquakeaffected the area. At this stagethere was little damage and veryfew deaths.

Six months later there wasanother large earthquake withsignificant destruction and over100 fatalities. This earthquakeoccurred in the middle of theacademic year and closed themedical school for 2 years. Usingstudents from the same cohortsstudying in different cities,and also historical controls, theimpact of these events onassessment outcomes wereinvestigated.

The impact of the first earthquakewas a significant reduction inassessment scores. The moresevere earthquake did not have a

significant impact on the assess-ment scores.

The authors speculate that thecause for this result may be that anacademic disruption that does notgive time for the student to developadaptive or coping strategies hasgreater impact on performance thana more severe disruption wherethere is time to adapt. Alterna-tively, they suggest that uncer-tainty and stress can stimulateanxiety, which can interfere withthe motivation to study.

This observational study providesevidence for educators around

A stressfulevent occurring

closer to anassessment will

have a muchgreater effect

than one that isdistant from the

assessment

Digest

134 � Blackwell Publishing Ltd 2013. THE CLINICAL TEACHER 2013; 10: 134–136

the impact of the timing ofstressful events on student per-formance. A stressful event

occurring closer to an assessmentwill have a much greater effect

than one that is distant from theassessment.

Selection and performanceLievens F. Adjusting medical school

admission: assessing interpersonal skills

using situational judgement tests.

Med Educ 2013;47:182–189.

Selecting medical students contin-ues to be a fertile area of research,and large-scale longitudinal stud-ies are now starting to appear. Thisarticle describes a study of 5444applicants to medicine, with suc-cessful applicants followed for upto 9 years. From these applicants1788 students commenced medi-cine and, after exclusions anddropouts, 927 were followed tograduation (7 years); 261 of thesewere followed into 2 years ofgeneral practice training.

The selection process consistedof cognitive tests and video-based situational judgement tests

(SJTs) to measure non-cognitiveskills. SJTs present applicantswith a realistic situation, in thiscase on video, and the applicantis asked to respond to the situa-tion. In this study applicants wereasked to respond to ‘What is themost effective response?’ on afour-choice multiple choice re-sponse developed for each of the30 videos used.

The outcome measures weregrade point average (GPA), non-interpersonal GPA and interper-sonal GPA at various points in theprogramme.

The cognitive selection testscorrelated significantly with thenon-interpersonal and overall GPAand knowledge test during gen-eral practitioner training, whereas

the SJTs correlated significantlywith interpersonal GPA as anundergraduate and the objectivestructured clinical examination(OSCE), doctor performance andinterview during general practi-tioner training.

The ability of selection proce-dures to predict performance9 years later is very impressive.This suggests that video SJTshave a major role in medicalstudent selection.

RemediationCleland J, Leggett H, Sandars J,

Costa MJ, Patel R, Moffat M. The reme-

diation challenge: theoretical and

methodological insights from a system-

atic review. Med Educ 2013;47:242–251.

The role of remediation for poorperformance in written and clin-ical examinations is an issueengaging many medical educa-tors. Remediating performanceafter an examination often leavesthe educator with the feeling thatthe student will only get intofurther academic difficulty in thefollowing year. This feeling isbased on bitter experience, butmay reflect a bias from recallingthe poor outcomes.

There is now evidence from aliterature review that supportsthis belief. Most of the reviewedstudies did not have controlgroups or adequate sample sizes,and were not based in theory. Itbecame impossible to determinewhat the most effective methodsfor remediation were.

The authors noted that mostremediation was undertaken toenable the student or youngdoctor to pass a re-sit examina-tion. Remediation that focused oncontent and examination tech-niques for a specific examinationwas reported in eight studies,only one of which reported long-

The ability ofselectionprocedures topredictperformance 9years later isvery impressive

� Blackwell Publishing Ltd 2013. THE CLINICAL TEACHER 2013; 10: 134–136 135