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Introduction Peer assessment enables students to evaluate peers, deepening their understanding of course objectives and boosting engagement. However, its dependability, especially in summative contexts, is often questioned. This study examines the dependability of peer assessments, and the optimal number of items and raters needed for a reliable assessment in project-based learning (PtBL). Methods In a PtBL class, 95 third-year pre-clinical students, grouped into ten teams, created 5-min videos on cardiovascular lifestyle modifications for the community, followed by a 5-min presentation on the video’s information and relevance to the citizen. Over three weeks, each group, guided by three advisors, refined their video. During presentations, peers (from nine non-presenting groups) and ten teachers (five Doctor of Medicines (MDs) and five health professors) evaluated the video presentation using a 6-item rubric covering three domains: interdisciplinary data integration, interpersonal skills, and video quality/effectiveness. Messick’s validity framework was utilized to guide the collection of validity evidence. Results Five sources of validity evidence were collected: 1) Content: Three professors confirmed the rubric’s content validity. 2) Response process: Scores from students, MDs, and health professors are similar at 54.00 ± 4.03, 53.24 ± 4.18, and 54.16 ± 4.16, respectively (F = 0.75, p  = 0.472). 3) Internal structure: A fully crossed design (p × i × r) generalizability theory analysis showed that achieving a Phi-coefficient ≥ 0.70 on a six-item rubric requires 27 students (Phi-coefficient = 0.70), 7 MDs (Phi-coefficient = 0.70), or 5 health professors (Phi-coefficient = 0.73). A nested design (r:(p × i)) demonstrated superior reliability, requiring only 9 students, 5 MDs, and 4 health professors for acceptable reliability. The confirmatory factor analysis indicated a good model fit. 4) Relations to other variables: On average, peer and teacher ratings scored 54.00 ± 2.22 and 53.70 ± 2.78, respectively, with an inter-rater reliability of r  = 0.73 ( p  = 0.016). 5) Consequences: Most groups found peer assessment beneficial for gaining insightful feedback (8/10), enhancing engagement (7/10), refining their work (5/10), and learning structured feedback (3/10), though there were concerns about potential bias (5/10). Conclusion Dependability evidence for peer assessment in the PtBL context was successfully gathered. In PtBL, students contribute to grading due to their diverse expertise. While peer assessment cannot replace teacher evaluations, it enhances engagement, enriches the learning environment, and improves assessment quality through valuable feedback.

Background Very Short Answer Questions (VSAQs) reduce cueing and simulate better real-clinical practice compared with multiple-choice questions (MCQs). While integrating them into formative exams has potential, addressing marking time and ideal occasions and items is crucial. This study gathers validity evidence of novel immediate self-feedback VSAQ (ISF-VSAQ) format and determines the optimal number of items and occasions for reliable assessment. Methods Ninety-four third-year pre-clinical students took two ten-item ISF-VSAQ exams on cardiovascular drugs. Each question comprised two sections: (1) Questions with space for student responses and (2) a list of possible correct answers offering partial-credit scores ranging from 0.00 to 1.00, along with self-marking and self-feedback options to indicate whether they fully, partially, or did not understand the possible answers. Messick’s validity framework guided the collection of validity evidence. Results Validity evidence included five sources: (1) Content: The expert reviewed the ISF-VSAQ format, and the question was aligned with a standard examination blueprint. (2) Response process: Before starting, students received an example and guide to the ISF-VSAQ, and the teacher detailed the steps in the initial session to aid self-assessment. Unexpected answers were comprehensively reviewed by experts. (3) Internal structure: The Cronbach alphas are good for both occasions (≥ 0.70). A generalizability study revealed Phi-coefficients of 0.60, 0.71, 0.76, and 0.79 for one to four occasions with ten items, respectively. One occasion requires twenty-five items for acceptable reliability (Phi-coefficient = 0.72). (4) Relations to other variables: Inter-rater reliability between self-marking and teacher is excellent for each item (r s (186) = 0.87–0.98, p  = 0.001). (5) Consequences: Path analysis revealed that the self-reflected understanding score in the second attempt directly affected the final MCQ score (β = 0.25, p  = 0.033). However, the VSAQ score did not. Regarding perceptions, over 80% of students strongly agreed/agreed that the ISF-VSAQ format enhances problem analysis, presents realistic scenarios, develops knowledge, offers feedback, and supports electronic usability. Conclusion Electronic ISF-VSAQs enhanced understanding elevates learning outcomes, rendering them suitable for formative assessments with clinical scenarios. Increasing the number of occasions effectively enhances reliability. While self-marking is reliable and may reduce grading efforts, instructors should review answers to identify common student errors.

Triglyceride-glucose (TyG) index is an independent risk factor for cardiovascular diseases (CVD). Our study determined the trends of the TyG index and its relationship to predicted CVD risk among patients with type 2 diabetes (T2D). A serial cross-sectional study was conducted including 63,815 participants with T2D aged 30–74 years without a history of CVD. The predicted CVD risk was based on the Framingham Heart Study (FHS). The receiver operating characteristic (ROC) curve was utilized for identifying the cutoff point of TyG index to predict intermediate-to-high CVD risk. The relationship between TyG index and predicted CVD risk was tested using linear and logistic regression. Decreasing trends of TyG index were observed between 2014 and 2018 ( p  < 0.001). ROC curve analysis of the TyG index indicated an AUC of 0.57 (95% CI 0.56–0.57, p  < 0.001) in predicting intermediate-to-high predicted CVD risk, with a cutoff value of TyG index > 9.2 (sensitivity of 55.7%, specificity of 46.8%). An independent relationship between the TyG index and predicted CVD risk was observed. High TyG index was independently associated with intermediate-to-high predicted CVD risk. From our study, the TyG index was positively related to predicted 10-year CVD risk. However, the predictive ability of the TyG index in predicting the intermediate-to-high predicted 10-year CVD risk among patients with T2D remained questionable.

Introduction Peer assessment can enhance understanding of the simulation-based learning (SBL) process and promote feedback, though research on its rubrics remains limited. This study assesses the validity and reliability of a peer assessment rubric and determines the appropriate number of items and raters needed for a reliable assessment in the advanced cardiac life support (ACLS) context. Methods Ninety-five third-year medical students participated in the ACLS course and were assessed by two teachers (190 ratings) and three peers (285 ratings). Students rotated roles and were assessed once as a team leader on a ten-item rubric in three domains: electrocardiogram and ACLS skills, management and mechanisms, and affective domains. Messick’s validity framework guided the collection of validity evidence. Results Five sources of validity evidence were collected: (1) content: expert reviews and alpha, beta, and pilot tests for iterative content validation; (2) response process: achieved acceptable peer interrater reliability (intraclass correlation = 0.78, p  = 0.001) and a Cronbach’s alpha of 0.83; (3) internal structure: demonstrated reliability through generalizability theory, where one peer rater with ten items achieved sufficient reliability (Phi-coefficient = 0.76), and two raters enhanced reliability (Phi-coefficient = 0.85); construct validity was supported by confirmatory factor analysis. (4) Relations to other variables: Peer and teacher ratings were similar. However, peers rated higher in scenario management; further generalizability theory analysis indicated comparable reliability with the same number of teachers. (5) Consequences: Over 80% of students positively perceived peer assessment on a 5-point Likert scale survey. Conclusion This study confirms the validity and reliability of ACLS SBL rubrics while utilizing peers as raters. Rubrics can exhibit clear performance criteria, ensure uniform grading, provide targeted feedback, and promote peer assessment skills.

Introduction: Very Short Answer Questions (VSAQs) minimise cueing and simulate actual clinical practice more accurately than Single Best Answer Questions, as multiple-choice options might not be realistic. Phramongkutklao College of Medicine has developed a Self-Marked VSAQ (SM-VSAQ) for formative assessments. This study determines the validity and reliability of the SM-VSAQs. Methods: Ninety-four third-year pre-clinical students took two occasions of 10-question SM-VSAQ exams regarding cardiovascular drugs. Each question consisted of two steps: (1) clinical vignettes with questions and (2) expected answers with scores, self-marking, and feedback comprehension. Scores ranged from 0.00 to 1.00 in 0.25 increments, though not every increment was applied to all questions. A distribution of the rating agreement between students' and teacher’s ratings was presented to determine criterion-related validity and inter-rater reliability. Results: Criterion-related validity revealed 90.64% and 93.19% of the ratings demonstrated exact agreement between students' and teachers' ratings, with an inter-rater reliability of 0.972 and 0.977 for the first and second occasions, respectively (p=0.001). The exact agreement was relatively lower on the first occasion for questions with more diverse expected answers (85.11%, r=0.867, p=0.001) and drugs requiring their specific full names for a perfect mark (74.47%, r=0.849, p=0.001). While questions with specific guides do not require complex answers, they received a higher exact agreement. Conclusion: The SM-VSAQ format effectively combines guided answers with the VSAQ model. The agreement with teacher-rated is excellent. Marking discrepancies rooted in misconceptions underscores the importance of teacher feedback in improving self-grading in formative assessments. Regular self-assessment practice is recommended to enhance grading accuracy.

Simulation-based learning (SBL) is effective for EKG interpretation training in the advanced cardiac life support (ACLS) context, enhancing motivation, confidence, and learning outcomes. However, research on the psychometrics of assessment rubrics for ACLS skills among pre-clinical students is limited. This study investigates the validity and reliability of assessment rubrics for ACLS skills, including EKG interpretation, scenario and pharmacological management, and teamwork. An SBL course that integrates basic EKG interpretation into ACLS Stations was conducted at Phramongkutklao College of Medicine, utilizing high-fidelity mannequins to simulate realistic scenarios, enrolling 96 medical students. The course consisted of five independent stations, and each student was assessed once by two raters using ten-item assessment rubrics. The rubrics included three domains: (1) EKG and ACLS algorithm skills, (2) management and mechanisms of action, and (3) affective domains. Validity evidence on the content was gathered, and construct validity was confirmed with confirmatory factor analysis (CFA). Inter-rater and internal consistency reliability were calculated. Generalizability theory was utilized to analyse the data. Three expert reviews yielded an item-objective congruence index of 0.67-1.00, with iterative validation through alpha and beta tests. The CFA demonstrated a good fit, but two questions with loading factors below 0.30 were removed, resulting in an eight-item assessment form. An inter-rater correlation of 0.70 (p < 0.001) and a Cronbach's alpha of 0.76 was demonstrated. To achieve a Phi-coefficient ≥0.80, three raters and at least 10 items are required in a p×i×r crossed design. With eight items, r:(p×i) nested design reliability was 0.69, 0.79, and 0.83 for one, two, and three raters, respectively. While a single rater with 10 items achieved a Phi-coefficient of 0.74. The rubrics for assessing ACLS skills among pre-clinical students demonstrated acceptable validity and reliability. A condensed eight-item rubric with acceptable reliability is proposed as a practical tool for optimizing assessment in future evaluations relevant to the pre-clinical context.

Background Engaging students in curriculum development provides valuable insights and promotes alignment with their learning needs. Premedical curricula often overemphasize basic sciences, highlighting the need to incorporate social sciences and earlier patient exposure. This study involved students as key stakeholders in redesigning and evaluating the curriculum's clinical relevance. Methods A two-phase mixed-methods study was conducted, guided by the context, input, process, product (CIPP) evaluation model. Phase one (context and input) utilized a 5-point Likert-scale questionnaire to assess perceptions of 380 students on premedical learning and its relevance to the preclinical curriculum, alongside open-ended suggestions. Student group activities identified key curriculum issues, informing revisions made in collaboration with the curriculum committee and student representatives, aligned with national medical competency standards. In phase two (process and product), 90 third-year students evaluated the revised curriculum using the same questionnaire with student representatives leading the process. Statistical analyses (Cramér's V, Chi-square, and t-tests) and content analysis were employed. Results In the previous curriculum, only 38.48% of students agreed/strongly agreed that premedical subjects aligned with preclinical learning, citing limited clinical relevance and disconnected content (n = 21). A student-led review, in collaboration with the curriculum committee, reduced pure science subjects and integrated them into more clinically relevant content, including early patient exposure in community settings, while maintaining alignment with national medical competency standards. The revised subjects were well received by students. Following these changes, 64.45% of students agreed/strongly agreed that it aligned with preclinical learning, and overall perception scores significantly increased from 18.03 ± 0.16 to 19.08 ± 0.35 (t = 2.819, p = .003). Conclusion A student-driven approach, supported by the CIPP model, helped redesign the premedical curriculum. It integrated relevant basic sciences with early community and clinical exposure to enhance alignment, engagement, and preparedness for clinical training.

Background Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide. The triglyceride to high-density lipoprotein cholesterol (TG/HDL) ratio has emerged as a potential marker for CVD risk. However, its predictive value for high 10-year predicted Cardiovascular (CV) risk remains unclear; This study evaluates the predictive value of the TG/HDL-C ratio for 10-year cardiovascular risk using the Framingham Heart Study (FHS) risk prediction model in individuals with Type 2 Diabetes Mellitus (T2DM). Methods A cross-sectional study was conducted on 61,004 adults from 2014,2015, and 2018 aged 30–74 years with T2DM, without a history of CVD. The FHS model was used to estimate 10-year predicted CV risk, and high CVD risk was defined as ≥ 20%. ROC curve analysis was used to determine the optimal TG/HDL cutoff for high 10-year predicted CV risk in the overall population and age-specific subgroups. Logistic regression was performed to find the association between TG/HDL and high 10-year predicted CV risk, adjusting for potential confounders. Results The optimal TG/HDL-C cutoff was 2.52 (AUC = 0.618, 95% CI: 0.612–0.624), with 67% sensitivity and 50% specificity. Higher TG/HDL were associated with increased odds of high predicted CVD risk in a dose-dependent manner, with an adjusted odds ratio (AOR) of 5.16 (95% CI: 4.86–5.49) in the highest TG/HDL quartile (> 4.91). Age-stratified analysis identified lower cutoffs for older adults (≥ 60 years: 2.42, AUC = 0.694) than younger individuals (< 60 years: 2.98, AUC = 0.636), indicating stronger predictive performance in older adults. Conclusions The TG/HDL ratio is significantly associated with 10-year predicted CVD risk in T2DM with age-specific differences in predictive value. The lower cutoff for older adults (2.42) suggests even modest elevations indicate increased risk. These findings support TG/HDL integration into routine CVD risk assessments and highlight the importance of age-specific cutoffs for improved risk stratification.

Background Insulin resistance (IR) is a major pathogenesis of nonalcoholic fatty liver disease (NAFLD). The triglyceride-glucose (TyG) index has recently gained popularity to assess IR and NAFLD due to its simplicity and low cost. The aim of the current study was to evaluate the relationship between the TyG index and aminotransferase. Methods A serial cross-sectional study was conducted among 232,235 Royal Thai Army (RTA) personnel aged 35–60 years from 2017–2021. Elevated aminotransferase was defined as ≥ 40 U/L and ≥ 35 U/L among males and females, respectively. A linear regression analysis between the TyG index and log-transformed aminotransferase was performed. High- and low-TyG index groups were divided according to Youden’s index cut point for predicting elevated aminotransferase. Multivariable logistic analysis was also utilized to investigate the association between the TyG index and elevated aminotransferase. Results The TyG index revealed a dose‒response relationship with log-transformed aminotransferase in both sexes and all age groups. The TyG index was positively associated with the prevalence of elevated aminotransferases. In comparison with the first TyG quartile (< 8.37), participants in the fourth quartile (> 9.23) had a higher chance for elevated ALT (AOR: 2.81, 95% CI: 2.71–2.90 for males and AOR: 4.01, 95% CI: 3.50–4.60 for females, P  < 0.001 for both). In the fourth TyG quartile, the prevalence of elevated ALT was 47.8% and 40.2% in the participants aged 35–44 and male participants, respectively. Conclusion A high TyG index is a novel risk factor for elevated aminotransferase among RTA personnel. Those with a high TyG index should be screened for elevated aminotransferase, particularly males aged 35–44 years.

Background Cardiovascular diseases (CVD) are the leading causes of death globally, including Thailand. Approximately one-tenth of Thai adults have type 2 diabetes (T2D), a significantly increasing CVD. Our study aimed to determine the trends of predicted 10-year CVD risk among patients with T2D. Methods A series of hospital-based cross-sectional studies were conducted in 2014, 2015 and 2018. We included Thai patients with T2D aged 30–74-year-old without a history of CVD. The predicted 10-year risk for CVD was calculated based on Framingham Heart Study equations both with simple office-based nonlaboratory and laboratory-based. Age- and sex-adjusted means and proportions of predicted 10-year risk for CVD were calculated. Results A total of 84,602 patients with T2D were included in the present study. The average SBP among study participants was 129.3 ± 15.7 mmHg in 2014 and rose to 132.6 ± 14.9 mmHg in 2018. Likewise, the average body mass index was 25.7 ± 4.5 kg/m 2 in 2014 and elevated to 26.0 ± 4.8 kg/m 2 in 2018. The age- and sex-adjusted mean of the predicted 10-year CVD risk (simple office-based) was 26.2% (95% CI: 26.1–26.3%) in 2014 and rose to 27.3% (95% CI: 27.2–27.4%) in 2018 ( p -for trend < 0.001). While the age- and sex-adjusted mean of the predicted 10-year CVD risk (laboratory-based) ranged from 22.4–22.9% from 2014 to 2018 ( p -for trend < 0.001). The age- and sex-adjusted prevalence of the high predicted 10-year CVD risk (simple office-based) was 67.2% (95% CI: 66.5–68.0%) in 2014 and significantly rose to 73.1% (95% CI: 72.4–73.7%) in 2018 ( p -for trend < 0.001). Nevertheless, the age- and sex-adjusted prevalence of the high predicted 10-year CVD risk (laboratory-based) ranged from 46.0–47.4% from 2014 to 2018 ( p -for trend = 0.405). However, among patients with available laboratory results, a significantly positive correlation was noted between predicted 10-year CVD risk, simple office-based and laboratory-based (r = 0.8765, p- value < 0.001). Conclusion Our study demonstrated significant rising trends in the predicated 10-year CVD risk among Thai patients with T2D. In addition, the results empowered further improved modifiable CVD risks, especially regarding high BMI and high blood pressure.