ObjectivesThe study aimed to compare candidate performance between traditional best-of-five single-best-answer (SBA) questions and very-short-answer (VSA) questions, in which candidates must generate their own answers of between one and five words. The primary objective was to determine if the mean positive cue rate for SBAs exceeded the null hypothesis guessing rate of 20%.DesignThis was a cross-sectional study undertaken in 2018.Setting20 medical schools in the UK.Participants1417 volunteer medical students preparing for their final undergraduate medicine examinations (total eligible population across all UK medical schools approximately 7500).InterventionsStudents completed a 50-question VSA test, followed immediately by the same test in SBA format, using a novel digital exam delivery platform which also facilitated rapid marking of VSAs.Main outcome measuresThe main outcome measure was the mean positive cue rate across SBAs: the percentage of students getting the SBA format of the question correct after getting the VSA format incorrect. Internal consistency, item discrimination and the pass rate using Cohen standard setting for VSAs and SBAs were also evaluated, and a cost analysis in terms of marking the VSA was performed.ResultsThe study was completed by 1417 students. Mean student scores were 21 percentage points higher for SBAs. The mean positive cue rate was 42.7% (95% CI 36.8% to 48.6%), one-sample t-test against ≤20%: t=7.53, p<0.001. Internal consistency was higher for VSAs than SBAs and the median item discrimination equivalent. The estimated marking cost was £2655 ($3500), with 24.5 hours of clinician time required (1.25 s per student per question).ConclusionsSBA questions can give a false impression of students’ competence. VSAs appear to have greater authenticity and can provide useful information regarding students’ cognitive errors, helping to improve learning as well as assessment. Electronic delivery and marking of VSAs is feasible and cost-effective.

ObjectiveTo assess the impact of a quality improvement project that used a multifaceted educational intervention on how to improve clinician's knowledge, confidence and awareness of acute kidney injury (AKI).Setting2 large acute teaching hospitals in England, serving a combined population of over 1.5 million people.ParticipantsAll secondary care clinicians working in the clinical areas were targeted, with a specific focus on clinicians working in acute admission areas.InterventionsA multifaceted educational intervention consisting of traditional didactic lectures, case-based teaching in small groups and an interactive web-based learning resource.Outcome measuresWe assessed clinicians’ knowledge of AKI and their self-reported clinical behaviour using an interactive questionnaire before and after the educational intervention. Secondary outcome measures included clinical audit of patient notes before and after the intervention.Results26% of clinicians reported that they were aware of local AKI guidelines in the preintervention questionnaire compared to 64% in the follow-up questionnaire (χ²=60.2, p<0.001). There was an improvement in the number of clinicians reporting satisfactory practice when diagnosing AKI, 50% vs 68% (χ²=12.1, p<0.001) and investigating patients with AKI, 48% vs 64% (χ²=9.5, p=0.002). Clinical audit makers showed a trend towards better clinical practice.ConclusionsThis quality improvement project utilising a multifaceted educational intervention improved awareness of AKI as demonstrated by changes in the clinician's self-reported management of patients with AKI. Elements of the project have been sustained beyond the project period, and demonstrate the power of quality improvement projects to help initiate changes in practice. Our findings are limited by confounding factors and highlight the need to carry out formal randomised studies to determine the impact of educational initiatives in the clinical setting.

The objective of the paper was to describe awareness of HIV medications and HIV viral load, and to assess the impact of HIV medications (including highly active antiretroviral therapy) and notions of viral load on sexual risk practices. This was an exploratory cross-sectional study of a non-random sample of 395 homosexually active Latino men in New York City. An anonymous self-administered questionnaire was used focusing on perceptions about HIV/AIDS, HIV treatment medications and viral load, risk perceptions, HIV status, and sexual partners and practices in the past 6 months. HIV-positive participants taking HIV medications, those who knew their viral loads, and those who had undetectable viral loads did not report significantly different frequencies of high-risk (receptive or insertive) unprotected anal intercourse (UAI) in comparison to other HIV-positive individuals in the sample. Perceptions about HIV status (assuming same status) and viral load (penetrating partner or letting partner penetrate one) were related to significantly higher high-risk UAI in the past 6 months. HIV prevention strategies for homosexually active Latino men should not only address the basic issue of assuming similar HIV status but also need to examine misconstructions of the transmissibility of HIV as a result of undetectable viral load.

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