Stefan Schauber¹
Shewatatek Gedamu Wonde²,¹
1 University of Oslo
2 Jimma University

Background
To improve health service coverage, Ethiopia has implemented a “flooding strategy” to health professions education and, across several years, established multiple medical schools across the country (1). In this context, a national medical licensing exam plays an important role to assure minimal standards of competency of medical graduates (2). In a joint project between Jimma University, Ethiopia, and the University of Oslo, Norway, we conducted a mixed- methods study to provide evidence for the quality of the Ethiopian licensing examination in medicine. 

Summary of work
We collected both qualitative (expert interviews) and quantitative data (student responses to exam items and expert judgments from standard setting). We will present background on the Ethiopian context of medical training and psychometric analyses of exam data. Preliminary results from the qualitative part of the study will be presented, too. 

Results 
Data on 600 items and N=2,213 candidates were collected. We analyzed results from three administrations of the medical licensing exam using both Classical Test Theory and Item Response Theory (IRT). Results indicate that the exams are sufficiently reliable, with coefficient alpha varying between 0.83 to 0.85. Comparable results were obtained from IRT analyses. Items generally fit well with the assumptions of IRT. More in-depth analyses indicated potential issues with distractors on selected multiple-choice items. 

Discussion
Our results indicate that the exams were reaching recommended standards of reliability. However, a closer look at the particular exam content is warranted. Finally, we will discuss future possibilities to address research questions using this dataset. 

Conclusions
MLEs are especially important in the given context using a “flooding strategy” to medical education. Future research should elaborate on differences between medical schools or gender- related differences in exam results. 

Take-home messages
We provide crucial evidence for the defensibleness of a high-stakes MLE in Ethiopia. 

References (maximum three) 

(1) Derbew M, Animut N, Talib ZM, Mehtsun S, Hamburger EK. Ethiopian Medical Schools’ Rapid Scale-up to Support the Government’s Goal of Universal Coverage. Academic Medicine. 2014 Aug;89(8):S40. 

(2) Price T, Lynn N, Coombes L, Roberts M, Gale T, de Bere SR, et al. The International Landscape of Medical Licensing Examinations: A Typology Derived From a Systematic Review. Int J Health Policy Manag. 2018 Apr 28;7(9):782–90. 

(3) Tavakol M, Dennick R. Post-examination interpretation of objective test data: Monitoring and improving the quality of high-stakes examinations: AMEE Guide No. 66. Medical Teacher. 2012 Mar 1;34(3):e161–75. 

Van Nguyen¹
James Bonnamy¹, Beata Starkowski², Adella Bhaskara^2,3, Apoorva Bisht², Niels Buus^1,4 and Gabrielle Brand¹
1 School of Nursing and Midwifery, Monash University, Australia
2 Lighthouse Foundation, Victoria, Australia
3 The University of Adelaide, School of Psychology, Australia
4 Department of Public Health, Aarhus University, Denmark

Background
The number of children and young people in foster care is growing in many countries including Australia. The impacts of out-of-home situations are profound including disadvantaged health and educational outcomes to young people. Foster caring can be challenging because children and young people often come into the foster care system traumatised. 

A training program was developed using Depth-of-Field co-design method involving educators/researchers, program coordinators of a Victorian foster care foundation, young people with experience in foster care, foster carers and supporters. Underpinned by Attachment Theory, trauma-informed principles and the foundation’s model of care, the training aimed to support foster carers in navigating fragmented systems while nurturing deep connection and building trusting relationships with children and young people. This research evaluates the impact of the training on foster carers’ and their family well-being. 

Summary of work
A mixed-methods design was applied using pre-and-post surveys and longitudinal diaries from training attendees. The surveys included two validated scales and questions to establish understanding of foster carers’ demographics, experience and prior training. The diaries entailed guided reflection on training application. 

Results
Quantitative data will shed light on participant demographics and changes in foster carers’ and their families' well-being post training. The qualitative data will provide in-depth understanding of training application and its effectiveness in the context of family foster care. 

Discussion
This research recognises the importance of foster care, the support needed by foster carers, and the evidence-based training program to ensure the well-being of foster carers and their families. 

Conclusions
This evaluation informs the evidence about effectiveness of the co-designed community-based training program to support foster carers of children and young people in their homes. 

Implications for further research
Further research is warranted to explore if this training is suitable for use in other community contexts and social services. 

References (maximum three) 

Font SA, Gershoff ET. Foster care: how we can, and should, do more for maltreated children. Soc Policy Rep 2020; 33:1–40. 

Australian Institute of Health and Welfare. Child protection Australia 2019-2020. 2021. 

Brand, Gabrielle, et al. A research approach for co-designing education with healthcare consumers. Medical Education 55.5 (2021): 574-581.