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Background and Objectives: The aim of the present research is to study the questions used in the 2018 MIR exam (a test that allows access to specialized medical training in Spain), describe their psychometric properties, and evaluate their quality. Materials and Methods: This analysis is performed with the help of classical test theory (CTT) and item response theory (IRT). The answers given to the test questions by a total of 3868 physicians are analyzed. Results: According to CTT, the average difficulty index for all of the test questions was 0.629, which falls into the acceptable category. The average difficulty index with correction for random effects was 0.515, which corresponds to a value within the optimal range. The mean discrimination index was 0.277, which is in the good category, while the mean point biserial correlation coefficient, with a value of 0.275 fits in the regular category. The values of difficulty and discrimination calculated according to the model of two parameters of the IRT seem adequate with average values of -0.389 and 0.677. The Cronbach alpha score obtained for the overall test was 0.944. This value is considered as very good. Conclusions: A decrease was observed in the average values of discrimination in the last three calls, which may be related to the greater proportion of Spanish graduates that take the exam in the same year of finalization of their studies in Medicine.

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Introducción: En España, el procedimiento reglado de acceso a la formación médica especializada tipo MIR exige la superación de un examen. El examen es un ejercicio tipo test de respuesta múltiple. Superado éste, se bareman los méritos académicos previos de los aspirantes. La ponderación de ambos valores permite sumarlos y ordenar a los aspirantes por su puntuación total. Los aspirantes tienen la oportunidad de elegir especialidad y centro de formación en función del número de orden obtenido. Sujetos y métodos: La base de datos utilizada en el presente trabajo contiene las respuestas de un total de 23.809 candidatos presentados a los exámenes MIR de las convocatorias comprendidas entre 2009 y 2017. La información disponible se analizó utilizando el índice de dificultad, índice de dificultad con corrección de los efectos del azar, índice de discriminación e índice de correlación puntual biserial, y las dificultades y discriminaciones se calcularon usando el modelo de dos parámetros de la teoría de respuesta al ítem. Resultados: Los resultados obtenidos en la serie temporal analizada permiten afirmar que la dificultad del examen ha disminuido en las tres últimas convocatorias. Además, la discriminación alcanza el valor mínimo en la convocatoria de 2016. Conclusiones: Dado el incremento en los últimos años del número de médicos españoles recién graduados que se presentan al examen, sería deseable mejorar la calidad psicométrica de las preguntas con el fin de que resulten al menos de la misma calidad como lo eran en los exámenes de convocatorias previas. La inclusión, por parte de la comisión calificadora, de criterios psicométricos de anulación de preguntas ayudaría a conseguir este objetivo

Introduction: In Spain, the regulated procedures of specialized medical training impose the passing of the MIR test. After this, the candidates choose the preferred specialty according to the order number obtained. The order number depends on the score of the applicant in the MIR exam and their academic record. Subjects and methods: The database used in the present research contains the responses of a total of 23,809 candidates submitted to the MIR exams since 2009 to 2017. The available information was analyzed using the difficulty index, difficulty index with correction of random effects, discrimination index, biserial point correlation index, as well as the difficulties and discriminations calculated using a two parameters model of the Item Response Theory. Results: The results obtained let us to say that the difficulty of the MIR test has decreased in the last three calls. In addition, the discrimination reaches the minimum value of the time series in the 2016 MIR test. Conclusions: Given the increase in recent years in the number of recently graduated Spanish doctors who take the MIR exam, it would be desirable to try to improve the psychometric quality of the questions in order to be at least as discriminative as the tests of previous calls. The inclusion by the committee of psychometric criteria of cancellation of questions would help achieve this objective

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Introducción: Aparato Digestivo es una de las especialidades ofertadas a los opositores que acceden a la formación sanitaria especializada cada año. Este proyecto analiza los datos de elección de Aparato Digestivo en los últimos años. Material y métodos: los datos de la elección se han obtenido de la publicación oficial de los actos de asignación de plazas del Ministerio de Sanidad, Servicios Sociales e Igualdad. Se ha recabado información de los distintos centros docentes a través de sus guías formativas, el Catálogo Nacional de Hospitales y la Organización Nacional de Trasplantes. Resultados: la mediana de elección de número de orden para Aparato Digestivo ha descendido anualmente, situando la especialidad en 2015 entre las cinco más populares en la elección. La mediana de los hospitales con mayor número de camas, actividad de trasplante hepático en adultos y Unidad de Sangrantes es significativamente menor. Lo mismo sucede al analizar los centros en base a la presencia de guardias específicas de Aparato Digestivo para residentes o vinculación con facultades de Medicina. Los datos de los últimos cinco años sitúan a Madrid, Aragón y Euskadi como las comunidades autónomas más populares. Los centros con menor mediana de número de orden para el periodo 2011-2015 fueron los hospitales universitarios Ramón y Cajal, Santiago de Compostela y Gregorio Marañón. Conclusiones: Aparato Digestivo ha ido mejorando de manera progresiva en la elección de plazas de especialización hasta llegar a situarse entre las cinco más populares. Los electores se decantan por centros grandes, de mayor complejidad asistencial y elevada actividad investigadora (AU)

Introduction: Gastroenterology is one of the medical specialties offered to residency training candidates each year. This project analyzes the data associated with the choice of a Gastroenterology residency program in recent years. Material and methods: Data related to specialty selection were obtained from official reports with regard to the allocation of residency places by the Spanish Ministry of Health, Social Services and Equality. Information was collected from various teaching centers via their training guides, the Spanish National Catalogue of Hospitals and the National Transplant Organization. Results: The median consecutive number involved in the choice of Gastroenterology training has decreased year after year, and this specialty is now positioned among the five most commonly selected residency programs in 2015. The median number of hospitals with a higher number of beds, adult liver transplantation activities and dedicated GI bleeding units is significantly lower. This is also true when centers are analyzed according to the presence of specific Gastroenterology on-call shifts for residents or their association with medical schools. Data from the past five years highlight Madrid, Aragón and the Basque Country as the autonomous communities where Gastroenterology is the most popular. Centers selected by candidates with the lowest median consecutive numbers from 2011-2015 included the university hospitals Ramón y Cajal, Santiago de Compostela and Gregorio Marañón. Conclusions: Gastroenterology has gradually escalated in the ranking of residency choices and is now one of the five most popular options. Potential residents prefer larger centers with complex-care patients and more research activity (AU)

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Introducción. El Ministerio de Sanidad, Servicios Sociales e Igualdad de España convoca anualmente el examen de acceso a la formación sanitaria especializada. La comisión calificadora de esta prueba es la encargada de aprobar el cuaderno de preguntas de examen e invalidar las preguntas que considere improcedentes. El presente trabajo propone una metodología de ayuda a la detección de preguntas susceptibles de anulación basándose en métricas de la teoría clásica de los test y de la teoría de respuesta al ítem. Sujetos y métodos. Para la realización del presente trabajo se usaron las respuestas a las preguntas del examen MIR de muestras de un total de 13.984 examinados de las convocatorias comprendidas entre 2010 y 2015. Resultados. Se obtuvieron 26 preguntas que, sin haber sido anuladas, serían susceptibles de serlo en función de los valores obtenidos de sus coeficientes de correlación biserial puntual y de discriminación en el modelo logístico de dos parámetros. Conclusiones. Existe una serie de preguntas que no son anuladas y cuya pobre calidad psicométrica empeora ligeramente la calidad global de la prueba MIR. Dado que esta prueba se realiza con el fin de ordenar en función de sus conocimientos a los médicos que desean acceder a una plaza de formación especializada, desde el punto de vista de los autores, sería recomendable que la comisión calificadora anulase todas las preguntas que presentan una mala calidad psicométrica, aun a costa de que el número final de preguntas válidas fuera ligeramente inferior a 225 (AU)

Introduction. Every year, the Spanish Ministry of Health, Social Services and Equality convenes the examination for access to specialized medical health training. The Qualification Commission of the exam is responsible for approving the test questionnaire and withdrawing the questions they consider to be inappropriate. The present work proposes a methodology to help detect questions that might be withdrawn based on the metrics of the Classical Test Theory and the Item Response Theory. Subjects and methods. For the accomplishment of the present work, the answers given by a total of 13,984 examinees to the questions of the MIR exam have been analyzed, using the exams between 2010 and 2015. Results. The authors propose the removal of 26 questions which, whilst not having been withdrawn by the Qualification Commission, would be susceptible to withdrawal based on the values of their point-biserial correlation coefficients and on discrimination in the two-parameter logistical model. Conclusions. There are a number of questions that have not been withdrawn whose poor psychometric quality slightly reduces the overall quality of the MIR test. Given that this test is done in order to classify physicians who want to gain a specialized training place, from the authors’ point of view it would be advisable for the Qualification Commission to withdraw all questions that present poor psychometric quality, even at the cost of making the final number of valid questions slightly fewer than 225 (AU)

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INTRODUCTION: Gastroenterology is one of the medical specialties offered to residency training candidates each year. This project analyzes the data associated with the choice of a Gastroenterology residency program in recent years. MATERIAL AND METHODS: Data related to specialty selection were obtained from official reports with regard to the allocation of residency places by the Spanish Ministry of Health, Social Services and Equality. Information was collected from various teaching centers via their training guides, the Spanish National Catalogue of Hospitals and the National Transplant Organization. RESULTS: The median consecutive number involved in the choice of Gastroenterology training has decreased year after year, and this specialty is now positioned among the five most commonly selected residency programs in 2015. The median number of hospitals with a higher number of beds, adult liver transplantation activities and dedicated GI bleeding units is significantly lower. This is also true when centers are analyzed according to the presence of specific Gastroenterology on-call shifts for residents or their association with medical schools. Data from the past five years highlight Madrid, Aragón and the Basque Country as the autonomous communities where Gastroenterology is the most popular. Centers selected by candidates with the lowest median consecutive numbers from 2011-2015 included the university hospitals Ramón y Cajal, Santiago de Compostela and Gregorio Marañón. CONCLUSIONS: Gastroenterology has gradually escalated in the ranking of residency choices and is now one of the five most popular options. Potential residents prefer larger centers with complex-care patients and more research activity.

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Introducción: En España, el acceso a la formación médica especializada, imprescindible para ejercer como médico especialista, se realiza a través de la prueba MIR. Superada esta prueba, los aspirantes pueden acceder a la formación en distintas especialidades ofertadas por numerosos hospitales a lo largo de todo el país. Sujetos y métodos: Para este trabajo se han utilizado las respuestas al examen MIR 2015 de un conjunto de 3.712 aspirantes. Resultados: Se calcularon los índices de dificultad y discriminación de todas las preguntas del examen. Las preguntas se analizaron según los valores de dichos índices y se agruparon por asignaturas, bloques y tipos de pregunta. Las preguntas con una mayor dificultad media fueron las pertenecientes a las asignaturas de fisiología, farmacología, geriatría, traumatología, neurología y cuidados paliativos. Las asignaturas cuyas preguntas mostraron valores menores de dificultad media fueron anatomía patológica, anestesiología, cirugía plástica, habilidades comunicativas, genética y enfermedades infecciosas. Conclusiones: En general, los valores de dificultad y discriminación de las preguntas de la prueba MIR resultan adecuados. La prueba discrimina mejor a los alumnos que demuestran conocimientos más bajos, y el valor óptimo de discriminación se encuentra en torno al percentil 25 de la muestra analizada (con una puntuación equivalente al percentil 41 de todos los médicos presentados al examen MIR 2015). Finalmente, se propone el uso de las metodologías propias de la teoría de respuesta al ítem con el fin de evaluar las preguntas de la prueba candidatas a ser anuladas

Introduction: In Spain, in order to gain access to specialised medical training it is mandatory to take the MIR exam. After passing said exam, the candidates can access training in different hospitals all around the country. Subjects and methods: This research was made using a database of the answers of 3,712 candidates who took the 2015 MIR exam. Results: The difficulty and discrimination index of all the questions in the exam were calculated. All the questions were analysed, taking into account the values of those parameters and classified by subject, block and kind of question. On average, those questions that were found to be most difficult correspond to the following subjects: physiology, pharmacology, geriatrics, traumatology, neurology and palliative care. The subjects with the least average difficulty were anatomical pathology, anaesthesiology, plastic surgery, communication skills, genetics and infectious diseases. Conclusions: Overall, the discrimination and difficulty values of the questions in the MIR exam are sufficient. The exam is more discriminatory for those students with the lowest discrimination levels, with percentile 25 having the highest levels. Finally, we propose that item response theory be employed as a support tool in order to decide which exam questions would be nullified

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Introducción: En España, para ejercer como médico especialista se requiere poseer la titulación de la correspondiente especialidad médica. Los procedimientos reglados de formación médica especializada imponen la superación de la prueba MIR para acceder a aquélla. Superada la prueba, los programas de formación MIR a los que se accede en los diferentes hospitales y unidades docentes son relativamente homogéneos. Objetivo: Efectuar una aproximación a la validez estructural del examen MIR de la última convocatoria (2015), realizado el 6 de febrero de 2016, haciendo especial énfasis en sus aspectos medibles. Sujetos y métodos: La base de datos utilizada en el presente trabajo corresponde a las respuestas a las preguntas del examen MIR de 2015 de una muestra de 3.712 examinandos. Resultados: El índice de dificultad medio de todas las preguntas fue de 0,6882, mientras que el índice de dificultad corregido fue de 0,5422; el de discriminación, de 0,2492, y el de correlación biserial puntual, de 0,2954. También se aplicó la fórmula número 21 de Kuder-Richardson y el alfa de Cronbach, que dieron como resultado 0,9459 y 0,9579, respectivamente. Los resultados obtenidos se compararon con los de los exámenes MIR comprendidos entre las convocatorias de 1989 y de 1993. Conclusiones: A la vista de los resultados psicométricos, es posible afirmar que el examen MIR es un examen objetivo, de dificultad y discriminación adecuadas, así como estructuralmente válido

Introduction: In Spain, to practice as a medical specialist, it is required to have the certification of the appropriate medical specialty. In order to have access to a medical specialist training programme, it is mandatory to overcome the MIR test. Passed the test, MIR training programs accessed in different hospitals and teaching units are relatively homogeneous. Aim: To approach to the structural validity of the MIR examination of the last call (2015), held on February 6, 2016, with particular emphasis on those measurable aspects of it. Subjects and methods: The database used in this study corresponds to the answers to the questions of the MIR exam of 2015 of a total of 3,712 examinees. Results: The average rate of difficulty of all questions was 0.6882, while the corrected index of difficulty was 0.5422, the discrimination of 0.2492 and 0.2954 the value of the point biserial correlation. The formula number 21 of Kuder Richardson and the Cronbach’s alpha were also applied giving as results 0.9459 and 0.9579 respectively. These values were compared with those obtained for the MIR test in the range from the calls 1989 to 1993. Conclusions: In view of the psychometric results, it can be said that the examination MIR is an objective, with an adequate level of difficulty and discrimination and also structurally valid

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BACKGROUND: The development of squamous cell carcinoma (SCCa) around dental implants is an uncommon pathological manifestation. This case report describes a patient with history of oral lichen planus (OLP) and previous SCCa of the gingiva who developed SCCa adjacent to symphyseal implants. CASE DESCRIPTION: An 81-year-old edentulous woman with history of OLP developed an in situ SCCa on the left mandibular edentulous ridge. One of the authors, an oral and maxillofacial surgeon, performed a marginal mandibular resection of the lesion. Functional oral rehabilitation was achieved by means of two endosseous symphyseal implants. Three years after the patient underwent implant-supported reconstruction, the oral and maxillofacial surgeon detected an exophytic mass adjacent to the right implant and diagnosed it as recurrent SCCa. Two of the authors performed a marginal mandibular resection. One year later, the patient developed a recurrence over the resected area, requiring segmental mandibulectomy. CLINICAL IMPLICATIONS: This case report demonstrates that recurrent primary malignancy can masquerade as benign peri-implant complications. A high degree of vigilance is required in the follow-up of patients with previous cancer or premalignant lesions.

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OBJECTIVES: Botryoid odontogenic cyst (BOC) is considered as an unusual multilocular variant of lateral periodontal cyst (LPC). Review of the literature indicates that this lesion has higher risk of recurrence than LPC, but objective reasons are still unknown. The aim of this study is identify main clinical and pathological variables associated with the risk of recurrence. STUDY DESIGN: A complete literature review about cases of BOC was made, from its first description up to the year 2006. A total of 67 cases of BOC were identified from year 1973 (first case) to the last publication in 2005. RESULTS: 85.2% of the BOCs were located in the jaw, affecting to women (54.8% of the cases) in the fifth decade of the life. This lesion shows a well- circumscribed unilocular (60%) or multilocular (40%) radiolucency. Recurrence rate of cases with follow-up data was 32,4%. CONCLUSIONS: Size and multilocular patterns could be the main factors associated to recurrence in BOC.

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Objetives. Botryoid odontogenic cyst (BOC) is considered as an unusual multilocular variant of lateral periodontal cyst (LPC). Review of the literature indicates that this lesion has higher risk of recurrence than LPC, but objetive reasonsare still unknown. The aim of this study is identify main clinical and pathological variables associated with the risk of recurrence. Study design. A complete literature review about cases of BOC was made, from its first description up to the year 2006. A total of 67 cases of BOC were identified from year 1973 (first case) to the last publication in 2005.Results. 85.2% of the BOCs were located in the jaw, affecting to women (54.8% of the cases) in the fifth decade of the life. This lesion shows a well- circumscribed unilocular (60%) or multilocular (40%) radiolucency. Recurrence rate of cases with follw-up data was 32,4%. Conclusions. Size and multilocular patterns could be the main factors associated to recurrence in BOC (AU)

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