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Over the last two decades, there have been a number of significant changes in the evaluation system in medical education in Korea. One major improvement in this respect has been the listing of learning objectives at medical schools and the construction of a content outline for the Korean Medical Licensing Examination that can be used as a basis of evaluation. Item analysis has become a routine method for obtaining information that often provides valuable feedback concerning test items after the completion of a written test. The use of item response theory in analyzing test items has been spreading in medical schools as a way to evaluate performance tests and computerized adaptive testing. A series of recent studies have documented an upward trend in the adoption of the objective structured clinical examination (OSCE) and clinical practice examination (CPX) for measuring skill and attitude domains, in addition to tests of the knowledge domain. There has been an obvious increase in regional consortiums involving neighboring medical schools that share the planning and administration of the OSCE and CPX; this includes recruiting and training standardized patients. Such consortiums share common activities, such as case development and program evaluation. A short history and the pivotal roles of four organizations that have brought about significant changes in the examination system are discussed briefly.
Critical thinking is the basis of professional nursing practice and is essential in the current complex health care delivery system. A major goal of baccalaureate nursing education is the development and promotion of students' ability to think critically. In America, the National League for nursing outcome-oriented accreditation process challenged nursing faculty to think about teaching and evaluating critical thinking. Based on nursing literature, the findings were inconsistent because of a lack of consensus on a definition of critical thinking and the measurement of critical thinking utilizing critical thinking instruments non-specific for nursing. However, a variety of teaching-learning strategies in nursing education were effective in the development of critical thinking dispositions and skills among nursing students. The author provides insight and ideas for nursing faculty as follows: 1) nursing programs must define critical thinking operationally in relation to their curricula; 2)nursing faculty must be knowledgeable concerning evaluation of critical thinking disposition and skills and construct a standardized critical-thinking instrument that is specific to the discipline of nursing; 3) nursing faculty must develop teaching-learning strategy in nursing education for improving students' critical thinking abilities. These are prerequisite for critical thinking which should be considered as a criterion in The Standards of Nursing Education in Korea.
Purpose: Senior nursing and medical interns' lack of familiarity and confidence with respect to practicing universal precaution for theprevention of occupational needlestick or sharp injuries may harm themselves. Trainees' self-reported needlestick or sharp injury ratewas known to be especially high during the first 2 months of internship in Taiwan. This prospective cohort study aimed to assess the effect of newly developed virtual reality (VR) game, which uses Gagne's learning model to improve universal precaution for needlestickor sharp injury prevention and decrease the rates of needle stick or sharp injuries in new-coming medical and nursing interns in Taiwan. Methods: From 2017 to 2019, the VR system was developed and applied in training of 59 new-coming nursing and 50 medical interns. Occupational needlestick or sharp injury prevention was sought to be achieved through a game of right and wrong choices for safe orunsafe universal precaution behaviors. Results: In comparison with medical interns, a higher proportion of nursing interns had past experiences of deep occupational needlestick or sharp injury. Before VR training, the familiarity and confidence for needlestick or sharp injury prevention were higher amongnursing interns than medical interns. Trainees with past experiences of deep needlestick or sharp injury exhibited better performanceon the accuracy rate and time needed to complete 20 decisions than those without past experiences in VR practice. All trainees showedan improved performance after VR training. A high proportion of trainees reported that the VR-based training significantly decreasedtheir anxiety about needlestick or sharp injury prevention. Conclusion: This self-developed VR game system using Gagne's flow improved universal precaution for needlestick or sharp injuryprevention and reduced the needlestick or sharp injury rates in the first 2 months of nursing and medical internship.
Purpose: Narrative medicine consists of the expression of medical experiences and the reflection on narratives to foster empathic communication with patients. Reflecting on narratives increases self-awareness and recognition of the feelings of the narrator or the story'smain character, which in turn affects the audience. This study was conducted to examine the impact of a narrative medicine program onthe reflective capacity and empathy of medical students. Methods: A quasi-experimental study was performed during the 2018–2019 academic year at Isfahan University of Medical Sciencesin Iran involving 135 medical interns in 2 groups (control [n=66] and experimental [n=69]). Interns in the experimental group tookpart in seven 2-hour reflective practice sessions, while those in the control group underwent no educational intervention. Pre-test andpost-test assessments were conducted for both groups using 2 valid and reliable tools for the assessment of reflective capacity and empathy. Mean reflection and empathy scores were compared within groups (between pre- and post-test values) and between groups (usingthe paired-t test and the t-test; P≤0.05). Results: The mean reflection and empathy scores of the experimental group significantly increased from pre-test to post-test, but thoseof the control group did not. Moreover, the mean post-test scores were significantly different between the 2 groups (P<0.001). Conclusion: Narrative medicine is an effective teaching method that can improve reflective capacity and empathy, thereby ultimatelypromoting professionalism as a core competency in medicine. Consideration of learning conditions and interdisciplinary teaching arenecessary for implementing a narrative medicine program.
PurposeSince 2004, the Korea Institute of Medical Education and Evaluation has been responsible for the evaluation and accreditation of medical schools in Korea. The 2nd cycle of evaluations was conducted from 2007 to 2011. The present study aimed at testing the goodness of fit of the items used in the 2nd cycle of evaluation and accreditation based on the Rasch model. MethodsDichotomous data on 40 medical schools were analyzed using Winsteps, a tool based on the Rasch model that includes goodness-of-fit testing. ResultsTwo of the 109 items had an outfit mean square exceeding 2.0. The other 107 items showed a goodness of fit in the acceptable range for the outfit mean square. All items were in the acceptable range in terms of the infit mean square. Furthermore, 1 school had an outfit mean square exceeding 2.0, while all schools were in the acceptable range for the infit mean square. An outfit mean square value over 2.0 means that an item is a outlier. Therefore, 2 items showed an extreme response relative to the overall response. Meanwhile, the finding of an outfit mean square over 2.0 for 1 school means that it showed extraordinary responses to specific items, despite its excellent overall competency. ConclusionThe goodness of fit of the items used for evaluation and accreditation by the Korea Institute of Medical Education and Evaluation should be checked so that they can be revised appropriately. Furthermore, the outlier school should be investigated to determine why it showed such an inappropriate goodness of fit.
It has been an issue whether the current medical examination system can evaluate medical students' competencies efficiently. This study was performed to survey on the satisfaction for the current medical examination system and present situation for clinical skill test in medical schools. We conducted a survey for this research and the subjects of this study were deans, medical professors, resident and medical students. We met with interesting results. First, most respondents answered the current medical examination system couldn't evaluate the medical students' competencies efficiently. Second, many residents thought preparing for paper-pencil test was not helpful for training, while experiencing clinical skill test was helpful for it. Third, the current contents and methods to evaluate clinical skill in the medical schools were variable and desirable. We concluded it was high time to change our medical examination system for evaluating the clinical skill performance of medical students.
Purpose: The Korea Medical Licensing Exam (KMLE) typically contains a large number of items. The purpose of this study was to investigate whether there is a difference in the cut score between evaluating all items of the exam and evaluating only some items whenconducting standard-setting. Methods: We divided the item sets that appeared on 3 recent KMLEs for the past 3 years into 4 subsets of each year of 25% each basedon their item content categories, discrimination index, and difficulty index. The entire panel of 15 members assessed all the items (360items, 100%) of the year 2017. In split-half set 1, each item set contained 184 (51%) items of year 2018 and each set from split-half set 2contained 182 (51%) items of the year 2019 using the same method. We used the modified Angoff, modified Ebel, and Hofstee methods in the standard-setting process. Results: Less than a 1% cut score difference was observed when the same method was used to stratify item subsets containing 25%,51%, or 100% of the entire set. When rating fewer items, higher rater reliability was observed. Conclusion: When the entire item set was divided into equivalent subsets, assessing the exam using a portion of the item set (90 out of360 items) yielded similar cut scores to those derived using the entire item set. There was a higher correlation between panelists' individual assessments and the overall assessments.
This study aimed to synthesize the best available qualitative research evidence on nurse educators' experiences with student incivility inundergraduate nursing classrooms. A meta-synthesis of qualitative evidence using thematic synthesis was conducted. A systematicsearch was performed of 12 databases for relevant literature published by March 31, 2019. Two reviewers independently conductedcritical quality appraisals using the checklist for qualitative research developed by the Joanna Briggs Institute. Eleven studies that metthe inclusion criteria were selected for review. From the pooled study findings, 26 descriptive themes were generated and categorizedinto the following 5 analytical themes: (1) factors contributing to student incivility, (2) management of student incivility, (3) impact:professional and personal damage, (4) impact: professional growth, and (5) initiatives for the future. Many nurse educators becameconfident in their role of providing accountability as both educators and gatekeepers and experienced professional growth. However,others experienced damage to their personal and professional life and lost their motivation to teach. Nurse educators recommended thefollowing strategies for preventing or better managing student incivility: institutional efforts by the university, unified approaches forstudent incivility within a nursing program, a faculty-to-faculty network for mentoring, and better teaching and learning strategies forindividual educators. These strategies would help all nurse educators experience professional growth by successfully preventing andmanaging student incivility.
Purpose: This study aimed to determine how the general course experiences of dental students in Chile and the satisfaction or frustration of their basic psychological needs influenced their passion for studying, and how passion influenced students' study strategies. Methods: A correlational cross-sectional study was conducted at 3 Chilean dental schools between April and June 2018, in which 935 undergraduate students participated. Students responded to Spanish-language versions of 4 psychological scale tools: the Course Experience Questionnaire, the Basic Psychological Needs Satisfac¬tion and Frustration Scale, the Passion Scale, and the Revised Study Process Questionnaire. Data were analysed with bivariate correlations and structural equation modelling, controlling for age, gender, year of study, and type of university. Results: Students' general course experiences (i.e., good teaching, clear goals and standards, appropriate assessment, and appropriate workload) positively predicted basic need satisfaction and negatively predicted need frustration. Need satisfaction positively predicted passion in students, with stronger scores for harmonious passion. Basic need frustration positively predicted obsessive passion and negatively predicted harmonious passion. Harmonious passion positively predicted deep study strategies and negatively predicted surface study strategies, while obsessive passion positively predicted both deep and surface study strategies. Conclusion: Dental students' optimal course experiences positively influenced the satisfaction of their basic psychological needs, which favoured harmonious over obsessive passion. In turn, harmonious over obsessive passion positively influenced deep study strategies. Therefore, efforts should be made to provide course experiences that support students' basic needs and harmonious passion for studying, both in classroom and chair-side teaching.