Malnutrition predicts poorer clinical outcomes for people with cancer. Older adults with cancer are a complex, growing population at high risk of weight-losing conditions. A number of malnutrition screening tools exist, however the best screening tool for this group is unknown. The aim was to systematically review the published evidence regarding markers and measures of nutritional status in older adults with cancer (age ≥ 70). A systematic search was performed in Ovid Medline, EMBASE, Web of Science, CINAHL, British Nursing Database and Cochrane CENTRAL; search terms related to malnutrition, cancer, older adults. Titles, abstracts and papers were screened and quality-appraised. Data evaluating ability of markers of nutritional status to predict patient outcomes were subjected to meta-analysis or narrative synthesis. Forty-two studies, describing 15 markers were included. Meta-analysis found decreased food intake was associated with mortality (OR 2.15 [2.03–4.20] p = < 0.00001) in univariate analysis. Prognostic Nutritional Index (PNI) was associated with overall survival (HR 1.89 [1.03–3.48] p = 0.04). PNI markers (albumin, total lymphocyte count) could be seen as markers of inflammation rather than nutrition. There a suggested relationship between very low body mass index (BMI) (<18 kg/m2) and clinical outcomes. No tool was identified as appropriate to screen for malnutrition, as distinct from inflammatory causes of weight-loss. Risk of cancer-cachexia and sarcopenia in older adults with cancer limits the tools analysed. Measures of food intake predicted mortality and should be included in clinical enquiry. A screening tool that distinguishes between malnutrition, cachexia and sarcopenia in older adults with cancer is needed.

Advances in the management of the multiple pregnancy and delivery must be accompanied by corresponding improvements in service access outside key centres and especially in the information families receive about what may happen during or after the pregnancy. A major review of birthing services in Victoria has focussed attention on four areas where the quality of information is often inadequate. 1) Prepregnancy and the standard of counselling about the incidence of multiples as a result of fertility drugs and in vitro fertilization procedures and about problems which may accompany a multiple birth. 2) Antenatal: At what stage of the pregnancy should parents be told of the multiple pregnancy and how should monitoring of the mother and procedures such as bedrest take into account what are often conflicting demands within the family? 3) Perinatal: Families are frequently illprepared for a cesarean delivery and for the procedures for premature multiples. The problem is often compounded by separation of the mother from one or both twins. While bereavement services are improving, much still needs to be learned about handling congenital abnormalities in one or more multiples. 4) Postnatal: Irrespective of the level of prenatal advice, families greatly underestimate the workload with multiples. The resulting stress contributes to the incidence of postnatal depression, child abuse and divorce now being reported from multiple birth families. Some suggestions are made from social psychology and genetic counselling about how families can best handle risk information to achieve the goal of neither under- nor overestimating the risks at these different stages of the multiple pregnancy.

Context Situational judgement tests (SJTs) are widely used to evaluate ‘non‐academic’ abilities in medical applicants. However, there is a lack of understanding of how their predictive validity may vary across contexts. We conducted a systematic review and meta‐analysis to synthesise existing evidence relating to the validity of such tools for predicting outcomes relevant to interpersonal workplace performance. Methods Searches were conducted in relevant databases to June 2019. Study quality and risk of bias were assessed using the Quality In Prognosis Studies (QUIPS) tool. Results were pooled using random effects meta‐analysis and meta‐regressions. Results Initially, 470 articles were identified, 218 title or abstracts were reviewed, and 44 full text articles were assessed with 30 studies meeting the final inclusion criteria and were judged, overall, to be at moderate risk of bias. Of these, 26 reported correlation coefficients relating to validity, with a pooled estimate of 0.32 (95% confidence interval 0.26 to 0.39, P < .0001). Considerable heterogeneity was observed (I2 = 96.5%) with the largest validity coefficients tending to be observed for postgraduate, rather than undergraduate, selection studies (β = 0.23, 0.11 to 0.36, P < .001). The correction of validity coefficients for attenuation was also independently associated with larger effects (β = 0.13, 0.03 to 0.23, P = .01). No significant associations with test medium (video vs text format), cross‐sectional study design, or period of assessment (one‐off vs longer‐term) were observed. Where reported, the scores generally demonstrated incremental predictive validity, over and above tests of knowledge and cognitive ability. Conclusions The use of SJTs in medical selection is supported by the evidence. The observed trend relating to training stage requires investigation. Further research should focus on developing robust criterion‐relevant outcome measures that, ideally, capture interpersonal aspects of typical workplace performance. This will facilitate additional work identifying the optimal place of SJTs within particular selection contexts and further enhancing their effectiveness.

BackgroundThe UK Clinical Aptitude Test (UKCAT) has been shown to have a modest but statistically significant ability to predict aspects of academic performance throughout medical school. Previously, this ability has been shown to be incremental to conventional measures of educational performance for the first year of medical school. This study evaluates whether this predictive ability extends throughout the whole of undergraduate medical study and explores the potential impact of using the test as a selection screening tool.MethodsThis was an observational prospective study, linking UKCAT scores, prior educational attainment and sociodemographic variables with subsequent academic outcomes during the 5 years of UK medical undergraduate training. The participants were 6812 entrants to UK medical schools in 2007–8 using the UKCAT. The main outcome was academic performance at each year of medical school. A receiver operating characteristic (ROC) curve analysis was also conducted, treating the UKCAT as a screening test for a negative academic outcome (failing at least 1 year at first attempt).ResultsAll four of the UKCAT scale scores significantly predicted performance in theory- and skills-based exams. After adjustment for prior educational achievement, the UKCAT scale scores remained significantly predictive for most years. Findings from the ROC analysis suggested that, if used as a sole screening test, with the mean applicant UKCAT score as the cut-off, the test could be used to reject candidates at high risk of failing at least 1 year at first attempt. However, the ‘number needed to reject’ value would be high (at 1.18), with roughly one candidate who would have been likely to pass all years at first sitting being rejected for every higher risk candidate potentially declined entry on this basis.ConclusionsThe UKCAT scores demonstrate a statistically significant but modest degree of incremental predictive validity throughout undergraduate training. Whilst the UKCAT could be considered a fairly crude screening tool for future academic performance, it may offer added value when used in conjunction with other selection measures. Future work should focus on the optimum role of such tests within the selection process and the prediction of post-graduate performance.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-016-0682-7) contains supplementary material, which is available to authorized users.

A situational judgement test (SJT) is an assessment whereby a candidate is presented with a specific scenario and must evaluate several possible responses to the scenario. The response format can vary but commonly involves ranking potential behavioural responses in order of either appropriateness or perceived effectiveness. Another commonly employed choice format involves a candidate choosing the 'best' and 'worst' behaviours depicted. An example of a Abstract Context: Historically, situational judgement tests (SJTs) have been widely used for personnel selection. Their use in medical selection in Europe is growing, with plans for further expansion into North America and Australasia, in an attempt to measure and select on 'non-academic' personal attributes. However, there is a lack of clarity regarding what such tests actually measure and how they should be designed, scored and implemented within the medical and health education selection process. In particular, the theoretical basis from which such tests are developed will determine the scoring options available, influencing their psychometric properties and, ultimately, their validity. Methods:The aim of this article is to create an awareness of the previous theory and practice that has informed SJT development. We describe the emerging interest in the use of the SJT format to measure specific constructs (eg 'resilience', 'dependability', etc.), drawing on the tradition of 'individual differences' psychology. We compare and contrast this newer 'construct-driven' method with the traditional, pragmatic approach to SJT creation, often employed by organisational psychologists. Making reference to measurement theory, we highlight how the anticipated psychometric properties of traditional vs construct-driven SJTs are likely to differ.Conclusions: Compared to traditional SJTs, construct-driven SJTs have a strong theoretical basis, are uni-rather than multidimensional, and may behave more like personality self-report instruments. Emerging evidence also suggests that construct-driven SJTs have comparable predictive validity for workplace performance, although they may be more prone to 'faking' effects. It is possible that construct-driven approaches prove more appropriate at early stages of medical selection, where candidates have little or no health care work experience. Conversely, traditional SJTs may be more suitable for specialty recruitment, where a range of hypothetical workplace scenarios can be sampled in assessments. S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. How to cite this article: Tiffin PA, Paton LW, O'Mara D, MacCann C, Lang JWB, Lievens F. Situational judgement tests for selection: Traditional vs construct-driven approaches. Med Educ. 2020;54:105-115.