Medical students' self-evaluation of character, and method of character education.

BACKGROUND: As medical doctors must have a strong sense of ethics, character education is particularly important for them compared with other professions. This follow-up study aimed to establish the foundation for developing a character education program in medical schools by (1) conducting a survey among medical students on the self-assessment of one's character based on eight qualities (service and sacrifice, empathy and communication, care and respect, honesty and humility, responsibility and calling, collaboration and magnanimity, creativity and positivity, patience and leadership), the perceived importance of character, and satisfaction with character education at medical school, and (2) analyzing the usefulness of learning methods for acquiring character elements. It also aimed at verifying the (3) gender differences in self-evaluation of character elements, and (4) academic-year differences in the survey items. METHODS: Medical students' perceptions were identified through a questionnaire survey among 856 medical students from five South Korean medical schools. The questionnaire comprised items on the achievement level of the character element, importance of character in the medical curriculum, satisfaction with character education in medical schools, and the learning method's degree of helpfulness. Descriptive statistics, t-test, and one-way ANOVA were used to compare responses. RESULTS: The importance of eight-character qualities had high average scores, whereas the average scores for satisfaction with character education and achievement level were comparatively low. For the question on each learning method's helpfulness in gaining the eight-character qualities, the score of team-based learning activities was the highest, followed by club activities, relationships with peers, role modeling of professors, and course study. Regarding satisfaction with character education, male students gave higher scores than female students, manifesting a statistically significant difference. Regarding the importance of the character element in medical education, statistically significant differences existed based on academic year. CONCLUSION: Medical students' perceptions of character education varied according to gender and academic year. They regarded character education highly but were unsatisfied with the current character education at medical schools. Thus, diverse character education curricula must be developed and implemented along with extra-curricular character programs. An effective approach to implementing character education can be discovered by verifying the differences in students' perceptions based on the character education courses in medical schools.

How do medical students differ in their interpersonal needs?

BACKGROUND: Knowing one's interpersonal relationship preferences can be tremendously helpful for medical students' lives. The purpose of this study was to examine the interpersonal needs in medical students. METHODS: Between 2010 and 2015, a total of 877 students from four Korean medical schools took the Korean version of the Fundamental Interpersonal Relations Orientation - Behaviour (FIRO-B) scale. The FIRO-B results were analyzed by descriptive statistics, frequency, independent t-test, and one-way ANOVA. RESULTS: The medical students' scores for interpersonal needs were moderate overall, with the highest scores for control (M = 8.63, SD = 3.08), followed by affection (M = 8.14, SD = 4.34), and inclusion (M = 7.81, SD = 4.30). Gender differences showed in three areas: expressed control (male > female, t = 4.137, p < 0.001), wanted affection (male < female, t = -3.148, p = 0.002), and control needs (male > female, t = 2.761, p = 0.006). By school type, differences were shown in expressed control (t = 3.581, p < 0.001), wanted inclusion (t = 2.625, p = 0.009), Inclusion (t = 1.966, p = 0.050), and expressed (t = 2.077, p = 0.038); undergraduate medical college (MC) students' needs were greater than the needs of graduate medical school (MS) students, but for wanted control, the MS students showed greater needs (t = -2.122, p = 0.034). CONCLUSIONS: There were differences in all categories except for expressed inclusion, wanted control, and control. The FIRO-B is a useful tool for giving insight into students regarding their interpersonal orientations, which will help them to adjust to medical school life. In addition, the FIRO-B can be useful when mentoring and coaching students.

Development of a character qualities test for medical students in Korea using polytomous item response theory and factor analysis: a preliminary scale development study

PURPOSE: This study aimed to develop a test scale to measure the character qualities of medical students as a follow-up study on the 8 core character qualities revealed in a previous report. METHODS: In total, 160 preliminary items were developed to measure 8 core character qualities. Twenty questions were assigned to each quality, and a questionnaire survey was conducted among 856 students in 5 medical schools in Korea. Using the partial credit model, polytomous item response theory analysis was carried out to analyze the goodness-of-fit, followed by exploratory factor analysis. Finally, confirmatory factor and reliability analyses were conducted with the final selected items. RESULTS: The preliminary items for the 8 core character qualities were administered to the participants. Data from 767 students were included in the final analysis. Of the 160 preliminary items, 25 were removed by classical test theory analysis and 17 more by polytomous item response theory assessment. A total of 118 items and sub-factors were selected for exploratory factor analysis. Finally, 79 items were selected, and the validity and reliability were confirmed through confirmatory factor analysis and intra-item relevance analysis. CONCLUSION: The character qualities test scale developed through this study can be used to measure the character qualities corresponding to the educational goals and visions of individual medical schools in Korea. Furthermore, this measurement tool can serve as primary data for developing character qualities tools tailored to each medical school's vision and educational goals.

Definition of character for medical education based on expert opinions in Korea.

PURPOSE: This follow-up study focused on 3 overarching questions: what keywords can be extracted from experts' definitions of character?; what is the operational definition of character for medical students?; and what possible solutions can be suggested to address the issues of character education that were identified in the previous study? METHODS: Sixty-three medical education experts recruited through expert sampling and 19 non-medical education experts recruited through snowball sampling answered a questionnaire that addressed the 3 major questions of the study. The responses were analyzed for descriptive statistics with supplementary keyword extraction tools, including the Cortical and Monkey keyword extractors. RESULTS: A total of 93 definitional statements were counted, and 138 keyword terms were extracted. The top 5 keyword terms mentioned by the medical education experts were "patient", "empathy", "qualities", "attitude", and "ability". These keyword terms were quite different from those mentioned by the non-medical education experts. Based on the extracted keywords, an operational definition of character education by the medical education expert group was presented as follows: the basic qualities and ability to empathize with patients affected by illness based on respect for patients and others. Various methods were proposed to solve the issue of character education, and many of them pointed to curriculum development, such as improvements in teaching and learning methods and evaluation methods, including role modeling. CONCLUSION: A clear statement of the concept of character education is the start to resolve issues of character education. Character education improvements will be possible at the institutional level according to the above results.

Core elements of character education essential for doctors suggested by medical students in Korea: a preliminary study

This preliminary study aimed to determine how medical students perceive character education in Korea. A structured survey questionnaire was distributed to 10 medical students between September and December 2018, of whom 6 students replied. Students' responses were classified into elements, which were also categorized. Twenty-nine core elements of characters in 8 categories were verified as essential for doctors and as needs for character education. The most frequently suggested categories were "care and respect," "empathy and communication," and "responsibility and calling." Participants also stated that various forms of character education are necessary and that they were not satisfied with the teaching methods of the character education that they had received. These results verified the most essential character traits for doctors and identified problems related to current character education. The results of this study will be helpful for preparing the character education curriculum in medical schools.

Identification and evaluation of the core elements of character education for medical students in Korea.

PURPOSE: Medicine requires uniquely high levels of motivation, ethics, and altruistic values and behavior. This study was conducted to redefine character education in medical education and to identify and evaluate the core elements of physicians' character. METHODS: A 3-round Delphi survey was conducted by professors of medical education, physicians, experts from nursing school, and head nurse in Korea. A consultant group (CG) was formed to prepare the Delphi survey, discuss the research results, and to set directions for future initiatives. The Delphi survey was conducted three times between September and November 2018. RESULTS: From the first-round Delphi survey, which inquired about the 10 key character elements required for medical students, a total of 420 elements were collected. The top 10 categories were selected and classified. After the second and third rounds of the Delphi consensus process and a series of CG meetings, the following 8 core categorical elements were identified: service and sacrifice, empathy and communication, care and respect, honesty and humility, responsibility and calling, collaboration and magnanimity, creativity and positivity, and patience and leadership. The average score of medical graduates for the core elements ranged from 2.45 to 3.46 (standard deviation: 0.23-0.60) on a 5-point Likert scale. CONCLUSION: Eight core categorical elements of the character of medical students were identified. The results of this study can be used as a reference for establishing goals and desired outcomes of character education at the level of undergraduate or graduate medical education.

Development of a systematic career coaching program for medical students.

PURPOSE: This study aimed to develop a systematic career-coaching program (SCCP) that can be used by medical teaching schools to address a growing need for career-coaching. The program objectives were to help students (1) develop a comprehensive self-understanding of their aptitudes, interests, and personality traits; (2) explore possible career choices and decide on a career path; and (3) develop the competencies needed to prepare for their future careers. METHODS: The SCCP was based on the ADDIE (analysis, design, development, implementation, and evaluation) model and decision-making questioning model. Medical professionals, medical education and career counseling experts, and students participated in designing the program. RESULTS: The SCCP describes coaching content, tools, operational methods, and appropriate timing, and identifies the professionals and specialists who can offer their expertise in the different coaching phases. It is designed to allow medical schools to offer the program in segments or in its entirety, depending on the curriculum and environment. CONCLUSION: The SCCP represents a viable career-coaching program for medical students that can be applied in part or in its entirety, depending on a medical school's curriculum and educational environment.

Exploring the possibility of one-on-one mentoring as an alternative to the current student support system in medical education.

PURPOSE: The purpose of this study was to explore the possibility of mentoring as an alternative to the current student support system based on our experiences of developing, operating, and evaluating a mentoring program. METHODS: In 2014 and 2015, a total of 29 mentoring pairs were selected to be trained as mentors and mentees. The mentoring program was evaluated by the following methods. First, at the end of the one-on-one mentoring program, the mentee made a presentation summarizing their experiences and submitted a portfolio. Second, suggestions from the mentors and mentees were gathered from a survey and from a focus group interview. The quantitative data were analysed using descriptive statistics, frequency, and the Mann-Whitney U-test using SPSS version 21.0. RESULTS: One-on-one mentoring sessions were carried out an average of five times during the semester. The topics of discussion were very diverse, including career coaching, personal counselling, journal club, field trips, leisure activities, and volunteering. Mentors and mentees showed high satisfaction rates regarding the content and administration of the program (mentors: 4.15±0.59, mentees: 4.00±1.58). However, the duration of the mentoring program was given a comparatively low rating (mentors: 3.15±1.09, mentees: 3.24±1.03). CONCLUSION: Overall, the implementation of the mentoring program was successful. Based on the content of the main activities, we can confirm the possibility of implementing an individualized support program for solving the mentoring issues faced by medical students.

Evaluation of a systematic career coaching program for medical students in Korea using the Career Readiness Inventory.

PURPOSE: The purpose of this study was to implement a systematic career coaching program for medical students and to evaluate its effectiveness. METHODS: First-year medical students of Konyang University College of Medicine took part in the FLEX Mentoring II: Career Coaching Program from September to December in 2016 and 2017. This program included 16 weekly sessions, comprising a total of 32 hours. The students took the Career Readiness Inventory before and after the program, as a pre- and post-test of the program. Data from 100 students were used (46 students in 2016, 54 students in 2017) for the evaluation. RESULTS: Medical students' career readiness pre-test was rated as medium. In particular, many students were at a low level in terms of 'support from colleagues and peers' (53.0%), 'career decision' (48.0%), and 'efforts for job preparation' (60.0%). After 16 sessions of a systematic career coaching program, their career readiness level showed a significant increase except for 'career decision' (t= 4.242, P= 0.001) and 'independence' (t= 0.731, P= 0.466), a sub-factor of 'career maturity.' CONCLUSION: The career readiness level of medical students was not sufficiently high. However, a semester of educational training in a systematic career coaching program helped the students to be better prepared for their career. In particular, the significant reduction in the 'career decision' variable after the program can be interpreted as indicating that the students changed their behavior to explore and approach their career more seriously and carefully, which also underscores the need for the implementation of career coaching programs in medical schools.

Different outcomes of active and reflective students in problem-based learning.

BACKGROUND: In the recent past, many medical schools have adopted the problem-based learning (PBL) method in their curriculum. AIM: The key in this type of learning is the small group, which encourages students to perform and, thus, to learn effectively. This means the students must be grouped in such a way for the small group to facilitate the achievement of a better learning outcome. METHODS: Using Felder's Learning Inventory, three groups of students were formed: active, reflective and a control with no particular propensity. RESULTS: Some interesting results were found. Active learners did not have the highest score in any of the tested areas. Instead, the reflective group of learners had the best outcome in participation, and the control group showed the best teamwork in a PBL setting. CONCLUSION: Overall, we have found that grouping students according to their varying learning styles can be very useful for specific and various learning outcomes.

Medical students' and patients' perceptions of patient-centred attitude.

PURPOSE: Patient-centred care can increase patient satisfaction and lead to better clinical outcomes for them, such as improved physical status and higher health-related quality of life. However, doctors' and patients' views on patient-centred attitude might differ and could be affected by culture and the community environment. To clarify the differences in primary care patients' and senior medical students' perceptions of medical students' patient-centred attitude. METHODS: A total of 1,025 subjects-827 patients from primary care institutions and 198 fourth-year medical students from a medical college in South Korea-completed the Patient Practitioner Orientation Scale (PPOS). The students completed the self-reported questionnaire at the end of their clinical clerkship. Descriptive statistics, t-tests, and one-way analysis of variances were conducted in SPSS version 21.0. RESULTS: Firstly, sharing subscale scores were higher among patients than among medical students (students, 3.61 vs. patients, 3.76; p<0.001), but secondly, caring subscale scores were higher among medical students (students, 4.18 vs. patients, 3.82; p<0.001). Thirdly, PPOS total scores were higher among medical students (students, 3.90 vs. patients, 3.79; p=0.001). Finally, male students had the lowest sharing scores (F=6.811, p<0.001) and female students showed the highest PPOS total scores (F=5.805, p=0.001). CONCLUSION: Significant differences between medical students' and patients' perceptions of medical students' patient-centred attitudes suggest the necessity of educational efforts to overcome the gap between the groups.

The job competency of radiological technologists in Korea based on specialists opinion and questionnaire survey.

PURPOSE: Although there are over 40,000 licensed radiological technologists (RTs) in Korea, job competency standards have yet to be defined. This study aims to clarify the job competency of Korean RTs. METHODS: A task force team of 11 professional RTs were recruited in order to analyze the job competency of domestic and international RTs. A draft for the job competency of Korean RTs was prepared. A survey was then conducted sampling RTs and the attitudes of their competencies were recorded from May 21 to July 30, 2016. RESULTS: We identified five modules of professionalism, patient management, health and safety, operation of equipment, and procedure management and 131 detailed job competencies for RTs in Korea. "Health and safety" had the highest average score and "professionalism" had the lowest average score for both job performance and importance. The content validity ratios for the 131 subcompetencies were mostly valid. CONCLUSION: Establishment of standard guidelines for RT job competency for multidisciplinary healthcare at medical institutions may be possible based on our results, which will help educators of RT training institutions to clarify their training and education.

Development of a career coaching model for medical students.

PURPOSE: Deciding on a future career path or choosing a career specialty is an important academic decision for medical students. The purpose of this study is to develop a career coaching model for medical students. METHODS: This research was carried out in three steps. The first step was systematic review of previous studies. The second step was a need assessment of medical students. The third step was a career coaching model using the results acquired from the researched literature and the survey. RESULTS: The career coaching stages were defined as three big phases: The career coaching stages were defined as the "crystallization" period (Pre-medical year 1 and 2), "specification" period (medical year 1 and 2), and "implementation" period (medical year 3 and 4). CONCLUSION: The career coaching model for medical students can be used in programming career coaching contents and also in identifying the outcomes of career coaching programs at an institutional level.

Measuring medical students' empathy using direct verbal expressions.

PURPOSE: Empathy is an important trait in physicians and a key element in the physician-patient relationship. Accordingly, one of the goals in medical education is developing empathy in students. We attempted to practically assess medical students' empathy through their direct verbal expressions. METHODS: The medical students' empathy was measured using the modified Pencil-and-Paper Empathy Rating Test by Winefield and Chur-Hansen (2001). The students took 15 minutes or so to complete the scale, and it was then scored by one of two trained evaluators (0 to 4 points for each item, for a total score of 40). The subjects were 605 medical students, and the data were analyzed using descriptive analysis, independent t-test, and one-way analysis of variance in SPSS version 21.0. RESULTS: The students' empathy scores were low (mean, 12.13; standard deviation, 2.55); their most common responses (78.6%) registered as non-empathetic. Differences in empathy were observed by gender (female students>male students; t=-5.068, p<0.001), school system (medical school>medical college; t=-1.935, p=0.053), and academic level (pre-medical 1 year < other years; t=-4.050, p<0.001). CONCLUSION: Our findings lead us to the significant conclusion that there is the need for empathy enhancement training programs with practical content.

How to provide tailored career coaching for medical students.

PURPOSE: This study was performed to develop a counseling strategy, based on the profiles of medical students' Strong Interest Inventory (STRONG) and Myer-Briggs Type Indicator (MBTI) results, focusing on the three following questions: Into what distinct levels are students categorized by STRONG and MBTI? and What is the dispersion of the integrated profiles? METHODS: Freshmen students from Konyang University College of Medicine who matriculated between March 2011 and 2013 were administered the MBTI personality type test and the STRONG interest inventory assessment. The integrated profiles were categorized per Kim et al. (2006), and frequency analysis was performed with the collected data, using SPSS version 21.0. RESULTS: Regarding MBTI types, 16.9% of students were categorized as ESTJ, and 12.9% was ISTJ. Further, 62.4% of students were Investigative (I) according to STRONG. The integrated profiles were divided into four types, according to their unclear/clear preference in the STRONG and MBTI results. Most students had 'clear preference and clear interest' (n=144, 80.9%), six students (3.4%) had 'clear interest but unclear preference,' and 28 students (15.7%) showed 'unclear interest but clear preference.' CONCLUSION: Using the combined results of the STRONG interest inventory assessment and MBTI tools, we can purvey more tailored information to students.

The relationship between ego-state and communication skills in medical students.

PURPOSE: The purpose of this study was to examine the relationship between ego-states and communication skills in medical students. METHODS: A total of 109 medical school students participated in this study, which used the communication skills self-test papers and the Egogram checklist. The data were analyzed by frequency analysis, and Pearson correlation analysis. RESULTS: Ego-state was related to communication skills. In particular, adapted child ego-state was negatively associated with each sphere of communication skills. CONCLUSION: Our results suggested that ego-state types should be considered in developing a communication skills education program for medical students.

The correlation between achievement goals, learning strategies, and motivation in medical students.

PURPOSE: The purpose of this study is to investigate the pursuit of achievement goals in medical students and to assess the relationship between achievement goals, learning strategy, and motivation. METHODS: Two hundred seventy freshman and sophomore premedical students and sophomore medical school students participated in this study, which used the Achievement Goals Scale and the Self-Regulated Learning Strategy Questionnaire. RESULTS: The achievement goals of medical students were oriented toward moderate performance approach levels, slightly high performance avoidance levels, and high mastery goals. About 40% of the students were high or low in all three achievement goals. The most successful adaptive learners in the areas of learning strategies, motivation, and school achievement were students from group 6, who scored high in both performance approach and mastery goals but low in performance avoidance goals. And goal achievement are related to the academic self-efficacy, learning strategies, and motivation in medical students. CONCLUSION: In the context of academic achievement, mastery goals and performance approach goals are adaptive goals.

How well do medical students express empathy?

PURPOSE: Empathy is an important trait of a physician and a key element in the physician-patient relationship. This study evaluated the ability to express empathy in medical students. METHODS: Medical student empathy was measured by the modified Pencil-and-Paper Empathy Rating Test of Winefield and Chur-Hansen. The subjects comprised 110 medical students. The data were analyzed by descriptive analysis and t-test using SPSS version 21.0 (IBM Corp.). RESULTS: Empathy rating test scores were low-level in medical students (mean, 12.59). There were no differences in the level of ability to express empathy between genders (t=-1.714, p=0.089). CONCLUSION: Our results suggest that practical training in expressing empathy should be included in medical education and that an empathy training program must be focused on changes in behavior.

[Operation of a school adaptation program considering the interpersonal needs of medical freshmen].

PURPOSE: We examined two overarching topics: What are the Fundamental Interpersonal Relations Orientation-Behavior (FIRO-B), Perceived Stress Scale (PSS), and Self-rating Depression Scale (SDS) scores in medical students? Do their interpersonal needs correlate with stress and depression? METHODS: FIRO-B, PSS-10, and SDS were administered to 82 freshmen in College of Medicine, The Catholic University of Korea in 2014. The data were analyzed by descriptive statistics, frequency, two-way analysis of variance, independent t-test, and Pearson correlation analysis using SPSS version 21.0 (IBM Corp.). RESULTS: The level of interpersonal needs was medium range (mean, 24.52). The mean perceived stress score was 18.6. Also, 59.8% and 40.2% of students had normal range (<20) and high stress (≥20). The mean score for depression was 36.3. Further, 97.6% and 2.4% of students had normal range (≤49) and mild depression (≤59). Wanted behavior correlated with stress (r=0.056) and depression (r=0.021). Expressed behavior correlated negatively with stress (r=-0.206) and depression (r=-0.301). CONCLUSION: The interpersonal needs of medical freshmen are related to stress and depression. These results can be used effectively in school adaptation programs for medical students to improve their quality of life.

Changes in medical students' patient-centeredness attitudes by implementation of clinical performance examination.

PURPOSE: From 2009, the Korean Medical Licensure Exam implemented a clinical performance examination (CPX) that highlighted the importance of good patient-physician relationships in medical education. This study aimed to examine changes in medical students' attitudes before and after implementation of the CPX in their medical education curriculum. METHODS: In 2006 and 2009, 236 fourth-year medial students of C College of Medicine took the Patient Practitioner Orientation Scale (PPOS) by Krupet et al. (2000), which measures patient-centered attitudes in patient-physician relationships. The data were analyzed by independent t-test and two-way analysis of variance using SPSS 21.0. RESULTS: The PPOS scores of year 2006 students were 3.88±0.25 for males and 3.98±0.38 for females. For year 2009 students, males scored 3.81±0.42 and females scored 4.01±0.48. All students had higher Care scores than Share scores (2006: Share, 3.67±0.47 vs. Care, 4.19±0.51; 2009: Share, 3.56±0.34 vs. Care, 4.18±0.53). There were significant differences in PPOS and Share scores by gender before and after the CPX. With regard to Care scores, female students' scores tended to rise and males' scores declined over time. CONCLUSION: An educational program is needed for students to foster patient-centered attitudes, but gender differences should be taken into account.