Assessment of medical students' clinical performance using high-fidelity simulation: comparison of peer and instructor assessment.

BACKGROUND: High-fidelity simulators are highly useful in assessing clinical competency; they enable reliable and valid evaluation. Recently, the importance of peer assessment has been highlighted in healthcare education, and studies using peer assessment in healthcare, such as medicine, nursing, dentistry, and pharmacy, have examined the value of peer assessment. This study aimed to analyze inter-rater reliability between peers and instructors and examine differences in scores between peers and instructors in the assessment of high-fidelity-simulation-based clinical performance by medical students. METHODS: This study analyzed the results of two clinical performance assessments of 34 groups of fifth-year students at Ajou University School of Medicine in 2020. This study utilized a modified Queen's Simulation Assessment Tool to measure four categories: primary assessment, diagnostic actions, therapeutic actions, and communication. In order to estimate inter-rater reliability, this study calculated the intraclass correlation coefficient and used the Bland and Altman method to analyze agreement between raters. A t-test was conducted to analyze the differences in evaluation scores between colleagues and faculty members. Group differences in assessment scores between peers and instructors were analyzed using the independent t-test. RESULTS: Overall inter-rater reliability of clinical performance assessments was high. In addition, there were no significant differences in overall assessment scores between peers and instructors in the areas of primary assessment, diagnostic actions, therapeutic actions, and communication. CONCLUSIONS: The results indicated that peer assessment can be used as a reliable assessment method compared to instructor assessment when evaluating clinical competency using high-fidelity simulators. Efforts should be made to enable medical students to actively participate in the evaluation process as fellow assessors in high-fidelity-simulation-based assessment of clinical performance in situations similar to real clinical settings.

Moving cell bodies: understanding the migratory mechanism of facial motor neurons.

Facial branchiomotor (FBM) neurons innervate facial musculature to control facial and jaw movement, which is crucial for facial expressions, speaking, and eating. FBM neurons are one of the largest populations among cranial motor neuronal class forming distinct nucleus in the hindbrain. To construct functional FBM neuronal system, a variety of cellular and molecular mechanisms play a role during embryonic development and thereby present a good framework for understanding the principles of neural development. Over the past decade, genetic approaches in mice and zebrafish have provided a better understanding of molecular pathways for FBM neuron development. This review will focus on regulatory mechanisms for cell body movement of FBM neurons, one of the unique features of FBM neuronal development. First, I will describe the basic anatomy of hindbrain, organization of cranial motor neurons, and developmental sequence of FBM neurons in vertebrates. Next, I will focus on the migratory process of FBM neurons in detail in conjunction with recent genetic evidence for underlying regulatory mechanisms, candidate environmental signals, and transcription factors for FBM neuronal development.