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SICRES’ 5th Anniversary

Celebrating SICRES’ 5th Anniversary: Evolving Insights and Perspectives on Clinical Trials

MSD Thailand signs an agreement with the Faculty of Medicine Siriraj Hospital, Mahidol University for the Clinical Site Partnership Project

MSD Thailand signs an agreement with the Faculty of Medicine Siriraj Hospital, Mahidol University for the Clinical Site Partnership Project on 24th April 2024

MOU signing ceremony between Syneos Health and the Faculty of Medicine Siriraj Hospital

Welcome to MOU signing ceremony between Syneos Health and the Faculty of Medicine Siriraj Hospital on 18th March 2024

Positive Results Announced in Largest Pivotal Phase 3 Trial of a First-in-Class Oral Antibiotic to Treat Drug-Resistant Gonorrhea

ผลลัพธ์เชิงบวกจากโครงการวิจัยระยะ 3 ที่ใหญ่สุดของยาปฏิชีวนะชนิดรับประทาน ประเภท First-In-Class เพื่อรักษาโรคหนองในดื้อยา

SICRES CPR Training 2023

ศูนย์วิจัยคลินิก คณะแพทยศาสตร์ศิริราชพยาบาล SICRES จัดกิจกรรม CPR Mock-up ประจำปี 2566

National Clinical Research Network (NCRN) Academic Conference

Siriraj Institute of Clinical Research (SICRES) is an academic clinical research institute, operating under the Faculty of Medicine Siriraj Hospital, Mahidol University. 

SICRES | ˈsīkres | , ไซ-เครส

"your success is our success", our mission, our quality policy, meet the director, professor kulkanya chokephaibulkit director, sicres management.

Assoc. Prof. Winai Ratanasuwan

Director of siriraj institute of clinical research.

Winai Ratanasuwan is Associate Professor specialized in infectious diseases and immunodeficiency.

• Doctor of Medicine (M.D.), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. (1986)
• Graduate Diploma in Clinical Medical Sciences (Internal medicine), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. (1990)
• Diploma of the Thai Board of Internal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. (1992)
• M.P.H., University of Washington, USA. (1995)
• Fellowship Infectious Diseases, Creighton University School of Medicine, Omaha, Nebraska, USA. (1998)
• Diploma of the Thai Board of Preventive Medicine (Clinical Preventive Medicine), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. (2001)
• Diploma of the Thai Board of Family Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. (2002)

Diploma of the Thai Subspecialty Board of Infectious Diseases, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. (2004)

Prof. Kulkanya Chokephaibulkit, MD

Consultant & Founding Director

Kulkanya Chokephaibulkit is Professor of Pediatric Infectious Diseases and Founding Director of the Siriraj Institute of Clinical Research.

Assoc. Prof. Somruedee Chatsiricharoenkul, MD

Vice Director, Shared Services

Somruedee Chatsiricharoenkul is Associate Professor of Pharmacology and Vice Director of the Siriraj Institute of Clinical Research.

Assoc. Prof. Dr.Pongsakorn Tantilipikorn, MD, PhD, FRCOT

Vice Director, Site Management Organization

Pongsakorn Tantilipikorn is Associate Professor in Rhinology & Allergy, and Chair of the Center of Research Excellence in Allergy & Immunology.

Assist. Prof. Dr. Suvimol Niyomnaitham, MD, MSCE, PhD

Vice Director, Clinical Research Support

Suvimol Niyomnaitham is Assistant Professor of Pharmacology and Vice Director of the Siriraj Institute of Clinical Research.

Prof. Kulkanya Chokephaibulkit , MD

Pongsakorn Tantilipikorn is Associate Professor in Rhinology & Allergy, and Chair of the Center of Research Excellence in Allergy & Immunology, Faculty of Medicine Siriraj Hospital.

SICRES conducts cost-effective clinical research at international standards and offers full-service clinical trial design and management. We offer a suite of capacities and services, including

• Experienced investigators and highly-trained clinical research staffs
• Precision clinical trial design and management (Phase I to IV)
• Bioequivalence studies, Feasibility surveys, Safety and Efficacy evaluations
• Integrated database development and biostatistical analysis
• Training and development of research staffs
• High impact medical publications and presentations
• Patient safety and adverse event monitoring
• A national and international research network
• Grant application support for investigators

Our Facilities

SICRES offers modern facilities that meet or surpass international standards. Our 30-bed research unit can accommodate overnight studies and has a synchronized clock system to assure protocol compliance. Each bed has a nurse call system, private restroom and 24-hour CCTV monitoring.

We have a comfortable patient waiting area, five examination rooms and a treatment room. SICRES also offers a secure conference room and private monitoring systems for investigators, sponsors and auditors. We maintain a secure filing and data archiving system to protect your data and assure patient confidentiality. We also operate separate fax systems for blinded and unblinded study staff. SICRES offers state of the art laboratory facilities including two 2-8°C, four sub 25°C refrigerators, one -20°C and three -80°C freezers.

All storage systems are maintained in 24-hour air-conditioned rooms with electronic remote notification of temperature variance. We have four refrigerated centrifuges, multiple biosafety cabinets and an emergency trolley equipped with a defibrillator and a 12-lead EKG.

Clinical Research Services

SICRES offers a full spectrum of clinical research services to bring about new and innovative solution and findings. Our services cover the entire clinical research and development that can be tailored to national and international trials. 

Feasibility Studies

Support the sponsors/CROs to evaluate the possibility of conducting a particular clinical trial at Faculty of Medicine, Siriraj Hospital or in a particular geographical region with the overall objective of optimum project completion in terms of timelines, targets and cost.

Contract Management

Assist the sponsors/CROs by facilitating Clinical Trial Agreement (CTA) process.

Regulatory Submission

Support sponsors/CRO on preparation of clinical research dossiers for submission to Regulatory Authorities.

Assist investigators on the Institutional Review Board (IRB) / Independent Ethics Committee (IEC) submission.

Clinic Facilities

Equipped with dedicated clinical research facilities for supporting ICH-GCP- standard clinical studies.

All such research facilities are properly maintained and are operated by professionally qualified and trained personnel.

Sample Management

Equipped with regularly calibrated and properly maintained equipment for supporting biological specimen management services.

Biosafety cabinet, refrigerated centrifuges and incubator are available for processing of specimens. All medical freezers are connected to 24-hour monitoring and alarm systems and supported by emergency power supply.

Statistical Analysis

Provide all-encompassing support, from consultation on the development of the statistical analysis plan to the creation of the statistical analysis report,

Perform statistical analyses to assess collected data objectively.

Clinical Operations

Our clinical operation services include: feasibility, site selection, contract negotiation and execution with clinical sites, clinical monitoring, supplying and retrieving investigational products, collection and checking case report forms, and processes for clinical studies closeouts.

Training and Education

Organizes various training programs for investigators, study coordinators, study nurses and other research staff to improve their capabilities to perform clinical trials.

Study Planning and Budgeting

Supports our investigators/partners in the planning of their studies and budgeting processes by clearly understanding the collaborators’ requirements and offering customized project proposals.

Payment Management

Supports financial accountability on the basis of transparency, traceability and auditability.

Complete records of all financial transactions are maintained, making financial audits simple and easy.

Bioequivalence Center

30-bed clinical research facility well-equipped to conduct BE trials – whether on small molecule drugs or biosimilars – as well as phase 1 and early phase trials.

Supporting generic drug manufacturers in planning, initiating, and completing their BE trials fulfilling the regulatory requirements.

Investigational Product Management

Support investigator on the investigational product management in conformity with Good Clinical Practices (GCPs).

Strictly controlled units accessible only to authorized pharmacists, dispensers, and study drug management personnel.

All study drug refrigerators are monitored by temperature data loggers and supported by emergency electricity backup, uninterrupted power supply and round-the-clock monitoring and alarm system.

Data Management

Provide highly professional, rapid, and exacting clinical data management services.

Our experienced staff assure the reliability of study’s data.

Medical Writing

Provide medical writing support for every stage in product development, from protocols, informed consent forms (ICF) to clinical study reports (CSR).

Project Management

Provides skilled project management support for timely delivery of project milestones and performance targets for clinical trials.

Coordinate all aspects of the study closely with the sponsor and team.

Manuscript editing service

Polish a manuscript draft until it is ready to submit. Consultation  service for writing medical articles is also provided.

Therapeutic Areas

Applied thai traditional medicine, dermatology, allergy and clinical immunology, cardiovascular, endocrinology and metabolism, gastroenterology, infectious disease and tropical medicine, nephrology & urology, respiratory disease and tuberculosis, rheumatology, obstetrics & gynaecology, ophthalmology, orthopedics, otorhinolaryngology, organization chart.

• +66 2 412 8306 , +66 2 414 1899
• [email protected]
• 10th floor, Siriraj Medical Research Center (SiMR) , Siriraj Hospital
• Bangkok Noi, Bangkok, THAILAND​
• Copyright © SICRES. All rights reserved.

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Cytotoxic activity of effector T cells against cholangiocarcinoma is enhanced by self-differentiated monocyte-derived dendritic cells

Affiliations.

• 1 Department of Biology, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand.
• 2 Siriraj Center of Research Excellence for Cancer Immunotherapy (SiCORE-CIT), 4th Floor Siriraj Medical Research Center (SiMR), Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
• 3 Center of Excellence in Bioresources for Agriculture, Industry and Medicine, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand.
• 4 Graduate Program in Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
• 5 Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
• 6 Cholangiocarcinoma Research Institute, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
• 7 Siriraj Center of Research Excellence for Cancer Immunotherapy (SiCORE-CIT), 4th Floor Siriraj Medical Research Center (SiMR), Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand. [email protected].
• PMID: 30056600
• PMCID: PMC11028072
• DOI: 10.1007/s00262-018-2212-2

Cholangiocarcinoma (CCA) is a cancer of the bile ducts that is associated with poor prognosis and poor treatment outcome. Approximately one-third of CCA patients can undergo surgery, but the recurrence rate is high and chemotherapy often cannot satisfactorily prolong survival. Cellular immunotherapy based on adoptive T-cell transfer is a potential treatment for CCA; however, the development of this technology and the search for an appropriate tumor-associated antigen are still ongoing. To enhance the cytotoxic activity of effector T cells against CCA, we developed self-differentiated monocyte-derived dendritic cells (SD-DC) presenting cAMP-dependent protein kinase type I-alpha regulatory subunit (PRKAR1A), which is an overexpressed protein that plays a role in the regulation of tumor growth to activate T cells for CCA cell killing. Dendritic cells (DCs) transduced with lentivirus harboring tri-cistronic cDNA sequences (SD-DC-PR) could produce granulocyte-macrophage colony-stimulating factor, interleukin-4, and PRKAR1A. SD-DC showed similar phenotypes to those of DCs derived by conventional method. Autologous effector T cells (CD3+, CD8+) activated by SD-DC-PR exhibited greater cytotoxic activity against CCA than those activated by conventionally-derived DCs. Effector T cells activated by SD-DC-PR killed 60% of CCA cells at an effector-to-target ratio of 15:1, which is approximately twofold greater than the cell killing performance of those stimulated with control DC. The cytotoxic activities of effector T cells activated by SD-DC-PR against CCA cells were significantly associated with the expression levels of PRKR1A in CCA cells. This finding that SD-DC-PR effectively stimulated autologous effector T cells to kill CCA cells may help to accelerate the development of novel therapies for treating CCA.

Keywords: Cellular immunotherapy; Cholangiocarcinoma; Cytotoxic T cells; Dendritic cells; Self-differentiated monocyte-derived dendritic cells.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

PRKAR1A expression in normal bile…

PRKAR1A expression in normal bile duct and CCA tissues. a Immunohistochemistry showing PRKAR1A…

PRKAR1A degradation. a PRKAR1A analyzed…

PRKAR1A degradation. a PRKAR1A analyzed by Western blot method in KKU-213 and KKU-055…

Analysis of dendritic cells derived…

Analysis of dendritic cells derived from human monocytes. a Results of flow cytometry…

Efficiency of SD-DC-PR to activate…

Efficiency of SD-DC-PR to activate effector T cells. a Ability of DCs to…

Efficiency of effector T cells…

Efficiency of effector T cells for killing CCA (KKU-213) cells after activation by…

Cytotoxic activity of effector T…

Cytotoxic activity of effector T cells, and PRKAR1A expression in CCA cells. Cytotoxic…

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• TRG5780173/TRF Grant for New Researcher

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• Open access
• Published: 23 August 2024

Test-enhanced learning in Neuroanesthesia for the First Year anesthetic residents: a randomized controlled trial

• Manee Raksakietisak 1 ,
• Vasu Lertsiripatarajit 1 ,
• Naiyana Aroonpruksakul 1 ,
• Narin Plailaharn 2 &
• Kasana Raksamani 1  

BMC Medical Education volume  24 , Article number:  905 ( 2024 ) Cite this article

Metrics details

Test enhancing learning (TEL) had shown a significant effect in promoting the learning of many learning contents. However, its effect on the postgraduate medical level was unclear. This study aimed to investigate the effect of TEL in 1st year anesthesiology residents learning neuroanesthesia.

The residents were randomized to either group A, which was assigned to do the intervention exam (exam A) for two times during learning in neuroanesthesia, or group B, which studied in the same environment without doing the exam. All participants were assigned to do the assessment exam (exam B) at one month after the end of the rotation. All of the exams were ten multiple choice questions (MCQ). Since the anesthesia residents rotated to neuroanesthesia for two weeks twice during the first year, we conducted the experiments twice, using exams that covered both basic science (BS) and clinical science (CS) topics.

There was no significant difference in mean ± SD of the scores for assessment exams asking about the basic science topic (BS_B) [group A (5.25 ± 2.05) VS group B (4.90 ± 1.80); p  = 0.570] and the clinical science topic (CS_B) [group A (6.30 ± 1.26) VS group B (5.95 ± 1.61); p  = 0.448].

This study showed null findings on the effect of TEL on learning in residents of the first year of anesthesiology. More studies on TEL were required to confirm the effect of TEL and find the appropriate test format that could enhance learning for post-graduate medical trainees.

Peer Review reports

Introduction

Anesthesia residents are required to master a vast amount of knowledge in a competency-based education system during their postgraduate training [ 1 ]. Competency-based medical education (CBME) emphasizes the achievement of specific skills and competencies, focusing on the residents’ ability to perform tasks to a predetermined standard [ 2 ]. This approach ensures that residents not only acquire theoretical knowledge but also develop practical skills and professional behaviors essential for patient care [ 3 ]. Retaining this knowledge can be challenging due to the demands of busy clinical work, high-pressure situations, and learning in complex environments [ 4 ]. Senior anesthesia residents have reported facing more challenges with academic education than with clinical learning experiences [ 5 ]. The implementation of entrustable professional activities (EPA) has been proven to bridge the gap between desired competency and clinical practices [ 6 ]. EPAs provide a structured framework that allows for the progressive entrustment of clinical responsibilities based on demonstrated competencies, enhancing the transition from learning to practice [ 6 , 7 ]. However, assessments focusing mainly on knowledge are still necessary to enhance other competencies [ 8 ].

The concept of test-enhanced learning (TEL) has been shown to improve memory and retrieval processes to learn new information [ 9 , 10 ]. Testing requires learners to actively retrieve data from memory, which strengthens retrieval pathways, making retrieval of these data easier in the future [ 11 , 12 ]. It also improves future learning by increasing correct recall [ 13 , 14 ]. Studies in cognitive psychology have shown that TEL encourages focusing attention on content, promotes task-relevant behaviors such as taking notes, and reduces overall cognitive demand [ 15 ]. TEL has demonstrated its effectiveness in various age groups, from elementary-aged students to middle-aged and older adults [ 16 , 17 , 18 ]. It has been applied at many educational levels, including medical education, and has shown significant effects in improving learning [ 9 , 11 , 15 , 19 , 20 , 21 , 22 , 23 ]. However, most TEL studies have been conducted with learners developing foundational knowledge and have produced inconsistent results at the postgraduate medical level [ 22 ].

In the context of residency training, particularly within a CBME framework, TEL can play a crucial role [ 1 , 2 ]. Residency training is characterized by its demanding nature, where residents must balance clinical duties with continuous learning and skill development [ 2 , 5 ]. TEL can help residents retain critical information and integrate it into their clinical practice, addressing one of the main challenges of postgraduate medical education—the retention and retrieval of extensive complex information [ 1 , 2 ]. This study aimed to investigate the effect of TEL on 1st-year anesthesiology residents’ learning of neuroanesthesia. We used multiple choice questions (MCQ) as the intervention, comparing them with residents who followed the standard training program. Furthermore, this study sought to identify other factors that could improve the learning of neuroanesthesia in first-year residents.

Study context

The residency training program in anesthesiology spans three years, employing a competency-based approach and an assessment system known as Entrustable Professional Activities (EPA). The clinical clerkship for neuroanesthesia includes rotations in neurosurgical operating theaters twice for two-week durations in the first year, one month in neuroradiology suites in the second year, and one month in neurosurgical operating theaters in the third year.

Learning experiences are enriched through one-on-one clinical supervision, simulation, prerecorded online lectures, exam pools, and self-directed learning, all integrated within the EPA system. During the neuroanesthesia clerkship, all residents were supervised by attending neuroanesthesiologists, with the level of supervision determined by the level of entrustment assessed by the EPA. In their second year, each resident participated in simulation sessions focused on neuroanesthesia for decision-making and anesthesia management. Additionally, at all times, residents had access to prerecorded online lectures on neuroanesthesia via the curriculum’s e-learning platform. At the conclusion of the first year, all first-year residents undertake a final exam in neuroanesthesia, consisting of 20 questions that encompass both basic and clinical sciences. This end-of-year exam is an integral part of the training evaluation.

This study received approval from the Siriraj Institutional Review Board (Si 642/2020). Participants were recruited from the first-year residents of the Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, during the academic year 2020–2021. The written informed consent was obtained from all participants before the data collection. However, 1st-year residents who began their rotation in neuro-anesthesia in the first month were excluded, as they were new trainees requiring a period for learning adaptation.

Participants were randomly divided into two groups: Group A and Group B, using block randomization. Group A, which served as the study group, underwent a pre-test, post-test, and final test. In contrast, Group B only took the final test. On the first day of their neuroanesthesia rotation (D1), only the participants in Group A took the pre-test (BS_A_1) and then repeated the same test on the last day (D15) of the rotation, termed the post-test (BS_A_2). Group A participants were instructed not to share the questions with their peers. After one month, at the end of the rotation (D45), both groups took the final test (BS_B).

The same process was repeated during the second rotation of neuroanesthesia, this time using the test for the clinical science topic. After completing all the tests, participants were asked to fill out questionnaires designed to gather demographic data, opinions about test-taking, learning habits, and the most effective methods for learning neuroanesthesia. The questionnaire was developed by a team of researchers by reviewing relevant literature and aligning it with the study’s objectives. It was a paper-based questionnaire administered to ensure ease of access and completion. Participation in the questionnaire was voluntary and anonymous, ensuring that responses could not be traced back to individual participants. The research methods are illustrated in Fig.  1 .

In this study, a total of four sets of multiple-choice questions (MCQ) were used. These comprised two sets focused on the basic science of neuro-anesthesia (BS topic) - specifically, Basic Science Exam A (BS_A) and Basic Science Exam B (BS_B) - and two sets centered on the clinical science of neuro-anesthesia (CS topic): Clinical Science Exams A (CS_A) and B (CS_B).

Both BS_A and BS_B contained ten questions that covered the same content but with varied questions. The same structure was observed for CS_A and CS_B. The decision to include ten questions in each exam was based on a previous study, which indicated that ten questions struck the right balance of efficiency and effectiveness [ 13 ]. Each question in these exams provided four answer choices. The “A” exams (BS_A and CS_A) functioned as intervention exams, while the “B” exams (BS_B and CS_B) served as assessment exams (refer to Fig.  1 ).

All questions were selected from an existing exam bank or specifically created for this study, aligning with the curriculum test blueprint. Three neuroanesthesiologists, each with over 5 years of experience in the field, evaluated the validity and suitability of every question.

Sequence of tests for participants in each group- BS_A_1 – the first attempt for the basic science exam A, BS_A_2 – the second attempt for the basic science exam A, CS_A_1– the first attempt for the clinical science exam A, CS_A_2 – the second attempt for the clinical science exam A, BS_B – the attempt for the basic science B, CS_B – the attempt for the clinical science B – D1 – 1 st day of rotation, D15 – 15 th day of rotation (last day), D45 – 45 th day (one month after the end of rotation)

- D1–1st day of rotation, D15–15th day of rotation (last day), D45- 45th day (one month after the end of rotation).

Statistical analysis

The sample size for this study was determined on the basis of a previous study. In that study, the average ± SD scores for the TEL group and the self-learning group were 53.91 ± 1.72 and 48.0 ± 1.8, respectively, representing a mean difference of 5 points out of 100 possible [ 16 ]. Given that the full score of our tests was 10, we projected the mean difference to be 1 point. After calculating the effect size and consulting with statisticians, it was determined that 34 participants, split equally into two groups, would be needed to achieve an 80% power. To compensate for possible participant withdrawals or for those who might not complete all tests according to the protocol, we decided to include an additional 10%, bringing the total to approximately 38 participants.

Given that the annual intake of first-year residents in the Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University ranges from 27 to 29, it was necessary to attract participants from at least two academic years.

Descriptive statistics were employed to assess demographic data, such as gender, and to capture participants’ perceptions about their learning. Group comparisons were made using Chi-square tests and Fisher’s exact tests. The Student’s t test was used to compare the scores of individual tests and the end-of-year exams between the two groups. A p-value below 0.05 was deemed statistically significant. Data analysis was carried out using IBM SPSS for Windows, version 23.0.

CONSORT flow

Demographic data

This study was conducted with every first year resident who consented to participate. Fifteen residents were excluded before randomization. A total of 40 participants completed all the exams according to the research protocol, with 20 participants in each group, as depicted in Fig.  2 . There were no statistically significant differences in terms of gender, age, grade point average (GPA), number of internship years, type of post-training hospital workplace, or availability of neuroanesthesia service at post-training hospital workplaces between the groups, as detailed in Table  1 .

Effect of TEL

The score for the first assessment exam, BS_B, did not differ significantly between Group A (5.25 ± 2.05) and Group B (4.90 ± 1.80) ( p  = 0.570). Similarly, the score for the second assessment exam, CS_B, for Group A (6.30 ± 1.26) and Group B (5.95 ± 1.61) also did not show a significant difference ( p  = 0.448). Furthermore, there were no significant differences between the end-of-year exam scores of the participants in Group A (13.7 ± 1.72) and Group B (13.1 ± 2.05) ( p  = 0.322), as illustrated in Table  2 .

Factors enhancing learning in Neuroanesthesia

Based on the questionnaires administered at the research’s conclusion, 65% of participants in group A reported that they felt they benefited greatly and very much from taking the MCQ exam compared to 50% of group B. The optimal parameters for the exam, as indicated by the participants, were 15 questions with a duration of 20 min, to be taken twice. After completing the exams, the majority of the participants reported spending 0–2 h on additional reading on neuro-anesthesia, as shown in Table  3 .

Regarding which methods most improved their learning in neuroanesthesia, some methods consistently ranked highly. To analyze the results, we assign scores of 3, 2, and 1 to the methods voted as the first, second, and third most learning-enhancing methods, respectively. The discussion of cases with supervisors for crucial insights received the highest score, followed by providing anesthesia for patients under close supervision by supervisors, and then providing anesthesia with distance supervision. These results are presented in Table  4 .

This study is a randomized controlled trial that investigated the effect of test-enhanced learning (TEL) on the knowledge of neuroanesthesia of first year anesthesiology residents. Participants who took the intervention MCQ tests during their neuroanesthesia rotation did not show a significantly different score on either of the assessment exams compared to participants who did not take the intervention exam. However, participants in the study group reported that the MCQ test had an educational impact, as they felt they learned from taking the test.

This result suggests that TEL may not have had a significant effect on the residents’ learning, unlike previous studies that reported a significant effect of TEL [ 16 , 22 ]. Therefore, we examined the differences between our protocol and theirs. One study used short answer questions (SAQ) and provided answers for each question as feedback on learning quizzes [ 22 ]. Consequently, we explored the reported effects of these two factors: the test format and the provision of feedback on TEL. The primary factor was the test format. Tests that encouraged students to generate answers on their own might offer a more potent TEL effect [ 15 , 24 ]. From a previous review, it was reported that there is an advantage of SAQ over MCQ and a benefit of context-rich MCQs (which require the application of knowledge) over context-free MCQs [ 20 ]. However, different test formats may be more suitable for various learning content and outcomes. MCQ tests might offer greater benefits for memorization and fact retention, while SAQ tests might be more useful for conceptual and abstract learning content [ 19 ]. Notably, the effects of TEL are stronger when the formats of the intervention and assessment tests are identical. It is essential to determine whether the increased scores result from improved knowledge or merely from familiarity and recognition [ 19 , 20 ]. Another factor to consider is providing feedback after the test. In this study, we did not show participants their scores or provide feedback on their responses to the intervention tests. The significance of feedback lies in its ability to correct erroneous responses during the test and to prevent students from being exposed to inaccurate information [ 24 ]. Feedback is also seen as an indirect testing effect since it guides students to focus on content areas that might require more attention [ 25 , 26 ]. The TEL effect is marginally better when feedback is provided after the test [ 19 ]. Interestingly, from the questionnaires given to the participants at the end of the protocol, some expressed a desire to know the correct answers.

The results of the questionnaires, which focus on self-reported factors that improve learning, showed that discussing cases with supervisors about vital points obtained the highest score. Participants noted that administering anesthesia under both close and distant supervision augmented their learning in neuroanesthesia. In contrast, self-testing ranked lowest. This pattern is consistent with the complexity of the competency-based curriculum in residency training, indicating that clinical content cannot be fully augmented by knowledge tests alone [ 4 ]. Integration of the cognitive, psychomotor, and affective domains of learning and assessment can be maximized using a competency-based approach [ 1 ]. The learning format in neuroanesthesia not only demands content knowledge but also an in-depth understanding of crucial operational points - insights frequently gleaned from hands-on experience. Consequently, introducing TEL to this kind of learning context might require modifications. The participants also highlighted the educational impact of the MCQ testing in the intervention group of the questionnaires. However, studies have illustrated that for assessments to offer educational advantages, they should not only cater to content but also to the depth and retention of learning [ 27 ]. A pivotal factor is the assessment’s ability to inspire learning motivation, be it through score acquisition, feedback, or interactions with assessors [ 28 , 29 ]. In our approach using the MCQ examination, learning motivation might stem from the exam’s familiar format and the feedback participants received in the form of scores.

We acknowledge several limitations in this study. First, the research was conducted in two academic cohorts, which could influence various contexts, such as the learning environment and students’ perceptions and motivations [ 30 , 31 ]. Second, the study was conducted in a single learning center. This environment may differ from others and is a crucial factor in learning. Third, the study sample size might have been too small to reveal a significant effect of TEL. Additionally, there was a lack of control between the groups, which could introduce variability and affect the results. Lastly, the limitations of the test questions included in the MCQ test should be considered. The selection process, while rigorous, may still have resulted in questions that did not fully encompass all relevant aspects of neuroanesthesia, potentially impacting the assessment’s comprehensiveness.

Although we did not find a significant effect of TEL on learning neuroanesthesia in this study, participants reported an educational impact from taking MCQs. Further research is needed to confirm TEL’s effect on learning and to design test formats that can effectively enhance learning.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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MR, VL, NA, NP and KR developed study concept and study design. All authors contributed to data acquisition. VL, MR and KR assisted with data analysis, drafting and revising the manuscript. All authors read and approved the final manuscript.

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All methods were carried out in accordance with the Declaration of Helsinki. After obtaining approval from the Siriraj Institutional Review Board (Si 642/2020). Participants were recruited from the first-year residents of the Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, during the academic year 2020–2021. The written informed consent was obtained from all participants before the data collection.

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Raksakietisak, M., Lertsiripatarajit, V., Aroonpruksakul, N. et al. Test-enhanced learning in Neuroanesthesia for the First Year anesthetic residents: a randomized controlled trial. BMC Med Educ 24 , 905 (2024). https://doi.org/10.1186/s12909-024-05887-0

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Zabaykalsky Krai, Russia

The capital city of Zabaikalsky krai: Chita .

Zabaykalsky Krai - Overview

Zabaykalsky Krai is a federal subject of Russia located to the east and southeast of Lake Baikal, part of the Far Eastern Federal District. Chita is the capital city of the region.

The population of Zabaykalsky Krai is about 1,043,500 (2022), the area - 431,892 sq. km.

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4 April, 2021 / The snow-covered Chara Sands in Eastern Siberia .

5 February, 2019 / Chita - the view from above .

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12 November, 2015 / Kuandinsky Bridge - one of the scariest road bridges in the world .

26 May, 2015 / Vanilla evenings of Transbaikalia .

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History of Zabaykalsky Krai

The first people inhabiting Transbaikalia, known both from archaeological finds and written sources (mainly Chinese), were the nomadic people of the Hunnu (209 BC - 93 AD), who created a large state in the Central Asian steppes. In the 6th-9th centuries, Turkic Uighurs lived in this region.

In 1206, Temujin was proclaimed the great khan of the Mongolian state and adopted a new name - Genghis Khan. The territory of the region became an integral part of the Mongol Empire. In the 14th century, the Mongolian Empire collapsed into separate states. Until the 17th century, the territory of the present Zabaykalsky krai was part of the Mongolian state of Northern Yuan.

From the middle of the 17th century, Transbaikalia became part of the Russian state. The first explorers crossed Dauria (the lands beyond Lake Baikal) along the rivers. The Buryats and Tungus, after a long resistance, recognized the new power and paid tribute to Russia. Several fortified towns were founded. Among the first colonists there were a lot of exiled old believers.

Since 1704, Nerchinsky, Shilkinsky, Gazimursky, and other silver smelters appeared. In the 18th century, the population of the region grew rapidly due to the influx of settlers and criminals, who worked in mines. Great role in the development of the region was played by the exiled members of the Decembrist uprising (brothers Bestuzhev, M.S.Lunin, N.M.Muravyov, C.G.Volkonsky, A.I.Yakubovich and others). From 1782, the region was a part of Nerchinskaya (Zabaykalskaya) Oblast of Irkutsk Governorate.

More Historical Facts…

Since the 19th century, mining was the main industry of the region. In 1851, Zabaykalskaya Oblast was formed with the capital in Chita as part of Irkutsk Governorate. In the same year, with the goal of strengthening the border, the Trans-Baikal Cossack Army was created, numbering more than 3,500 people. At the end of the 19th century, the construction of the Trans-Siberian Railway forced the economic development of the region.

At the end of the 1920s - in the early 1930s, during collectivization, Cossack settlements were destroyed, the Buryat cattle-breeders were forced to have a settled way of life. In March 1934, Chita Oblast was formed, it became a part of Vostochno-Sibirsky Krai. On September 26, 1937, Vostochno-Sibirsky Krai was divided into Irkutsk and Chita oblasts. Within Chita Oblast there was Aginsky Buryat-Mongol national district formed.

During the Second World War, tens of thousands of local residents were drafted into the Soviet army. In connection with the threat of an attack by the Kwantung Army of Japan, the Transbaikal front was established here. In 1945, after the defeat of Nazi Germany, the Soviet Union began military operations against Japan.

Until 1949, about 77 thousand Japanese prisoners of war were engaged in work to restore the region. The local economy was completely restored by the 1950s. In 1969, there was an armed conflict on the Soviet-China border close to the frontier point of Nizhne-Mikhailovka on the Damansky Island.

In the 1990s, there was a sharp decline in industrial and agricultural production. On March 1, 2008, in the territory of Chita Oblast and the Aginsky Buryat Autonomous Okrug, a new federal subject of Russia was created - Zabaykalsky Krai.

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Hilly landscape in the Zabaykalsky region

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Zabaykalsky Krai - Features

Zabaykalsky Krai is located in Eastern Siberia. The greatest length from north to south is about 1,000 km, from west to east - 850 km. The highest point on the territory of the region is the peak of BAM (3,073 meters). The relief is represented by both plains and mountains, but mountains are predominant in the region.

The south and south-eastern borders of Zabaykalsky Krai are the state border of the Russian Federation with Mongolia and the People’s Republic of China. The largest rivers are the Argun, Shilka, Onon, Ingoda, Khilok, Chikoy. The national composition according to the 2010 census: Russians (89.9%), Buryats (6.8%).

The climate is sharply continental. Winters are long and severe, the average temperature in January ranges from minus 20 degrees Celsius in the south to minus 37 degrees Celsius in the north. Summers are short and warm (sometimes hot), the average temperature in July - about plus 20 and 13 degrees Celsius respectively.

This region of Russia has large reserves of coals, iron ores, silver, copper, tungsten, tin, antimony, lithium, tantalum, niobium, zircon, germanium, and uranium. Forests occupy about 60% of the region. The main problem of the forest area is the annual destruction of thousands of hectares of forest by natural fires.

Mining remains the main industry of the region. Ferrous metallurgy is developed as well as machine-building, timber industry, light and food industries. Agriculture is specialized in cattle- and sheep-breeding. In the north of the region reindeer-breeding and fur trade are developed. The crops grown are wheat, barley and oats.

Tourism in Zabaykalsky Krai

The border position of Zabaykalsky Krai promotes the rapid development of cross-border tourism. It has become the main “tourist gateway” for tourists coming from the Asia-Pacific region. The territory of the Zabaykalsky region has a wide variety of natural landscapes, unique monuments of nature.

Sports tourism with elements of extreme has always been attractive for tourists: rafting (the Burkal, Menza, Onon rivers), rock climbing, horseback riding, and bicycle travel. For these purposes more than 100 sports and tourist routes have been developed.

Ethno-tourism is associated with the culture of small peoples, such as the Evenks. Tours on reindeer are held. Chita, Nerchinsk, Sretensk, Petrovsk-Zabaikalsky, and Shilka have the status of historical settlements. On the territory of Zabaykalsky Krai ancient settlements of the Huns were discovered. The events attracting guests include the Trans-Baikal International Film Festival, the tourist festival on Kodar.

The main sights of Zabaykalsky Krai:

• Alkhanay National Park in Duldurginsky district - the only place in Russia where a harmonious system of cult Buddhist and natural monuments has been created;
• Krasniy Chikoy, the center of Krasnochikoysky district, is one of the oldest and most beautiful villages in the region;
• Mineral springs. The nearest mineral spring to Chita is Molokovka, a good place for taking pictures in nature;
• Mount Pallasa, located near Chita, is a monument of nature of regional importance;
• Zabaykalsky Alps - Kodar. In the north of the region there is an amazing country of contrasts and surprises - Charskaya depression with the surrounding mountain ranges. It is known for such monuments of nature as Kodar ridge with the highest point of Transbaikalia, Chara Sands - a miniature desert 10 km long;
• Lake Arey - a hydrological monument of nature, one of the favorite places for recreation. The lake is located in a picturesque forest area near the highway Chita-Khilok;
• Haatei Caves - two caves connected by a narrow passage. The first cave is called Ice, in winter, when water flows into the cave and freezes, you can see very beautiful patterns there. The second cave is considered a summer cave and is called Dry;
• Butinskaya Estate in Nerchinsk - the main attraction of this historical town;
• Old-Chita Mikhailo-Arkhangelsk Church (also known as Church of the Decembrists) is the oldest building in Chita where a museum dedicated to the Decembrists is located;
• Museum of the Decembrists in the town of Petrovsk-Zabaikalsky;
• Konduisky settlement - one of the monuments of Genghis Khan’s epoch.

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