The relationship between medical students' epistemological beliefs and achievement on a clinical performance examination.

PURPOSE: This study was to explore the relationship between clinical performance examination (CPX) achievement and epistemological beliefs to investigate the potentials of epistemological beliefs in ill-structured medical problem solving tasks. METHODS: We administered the epistemological beliefs questionnaire (EBQ) to fourth-year medical students and correlated the results with their CPX scores. The EBQ comprised 61 items reflecting five belief systems: certainty of knowledge, source of knowledge, rigidity of learning, ability to learn, and speed of knowledge acquisition. The CPX included scores for history taking, physical examination, and patient-physician interaction. RESULTS: The higher epistemological beliefs group obtained significantly higher scores on the CPX with regard to history taking and patient-physician interaction. The epistemological beliefs scores on certainty of knowledge and source of knowledge were significantly positively correlated with patient-physician interaction. The epistemological beliefs scores for ability to learn were significantly positively correlated with those for history taking, physical examination, and patient-physician interaction. CONCLUSION: Students with more sophisticated and advanced epistemological beliefs stances used more comprehensive and varied approaches in the patient-physician interaction. Therefore, educational efforts that encourage discussions pertaining to epistemological views should be considered to improve clinical reasoning and problem-solving competence in the clinic setting.

[The relationship between problem-based learning and clinical performance evaluations].

PURPOSE: To explore the relationship between problem-based learning (PBL) evaluations and clinical performance. METHODS: The study included 117 third-year medical students at Chonnam National University Medical School. The students' first-, second-, and third-year PBL evaluations were compared with their clinical performance examination (CPX) scores in third year. The PBL evaluations were composed of three subscales: tutors' evaluation (students' professional behavior, contribution to group process, and contribution to group content), a report, and a written examination. The CPX assessed four performance categories: history taking, physical examination, information sharing, and patient-physician interaction. RESULTS: No significant correlation was found between the first-year PBL evaluations and CPX scores; however, the second-year PBL evaluations were significantly correlated with history taking (r=0.186, p=0.044) and patient-physician interaction (r=0.213, p=0.021) of CPX. The third-year PBL evaluations were significantly correlated with physical examination (r=0.248, p=0.007), and patient-physician interaction (r=0.283, p=0.002) of CPX. Several significant correlations between the PBL evaluations subscales and CPX scores were revealed. The PBL tutors' evaluation (r=0.343, p=0.000) and report scores (r=0.210, p=0.023) were significantly correlated with patient-physician interaction of CPX. The contribution to group process of tutors' evaluation was significantly correlated with patient-physician interaction (r=0.186, p=0.045), and the contribution to group content of tutors' evaluation was significantly correlated with physical examination (r=0.187, p=0.044). CONCLUSION: We found a significant association between PBL evaluations and CPX scores.

Mentoring experience and its effects on medical interns.

INTRODUCTION: Effective mentoring helps interns in the early stages of their medical career to reach personal and professional goals. This study investigated the mentoring experience of Korean interns during medical internship and evaluated mentoring effects to facilitate the development of future mentoring programmes. METHODS: Participants were interns being trained at Chonnam National University Hospital, South Korea, in 2011. Interns were asked to complete a questionnaire about their mentoring experiences and job satisfaction. RESULTS: A total of 61 medical interns participated in the study, giving a response rate of 70.1%. Among these interns, 26 (42.6%) had mentoring experiences, with an average of 2.3 ± 1.9 mentors per mentee. Mentees usually discussed career planning and concerns regarding their personal and social lives with their mentors. Perceived quality of the mentor was significantly more important for male mentees than for female mentees. Female interns without a mentor made significantly less effort to seek a mentor than their male counterparts. Having and not having a mentor resulted in significant differences in the interns' job satisfaction. CONCLUSION: Fewer than half of the medical interns had mentoring experiences. Results suggest that the mentoring relationship may be less satisfying and more challenging for female interns. Effective mentoring may not only help interns plan their medical career, but also increase job satisfaction. Mentoring programmes during medical internship should be expanded and supported, as it is the initial step in a medical career.

Advance organizers in a gross anatomy dissection course and their effects on academic achievement.

We presented two kinds of advance organizers (AOs), video clips and prosection, for a gross anatomy dissection course and compared their effects on academic achievement and student perception of the learning experience. In total, 141 students at Chonnam National University Medical School were randomly assigned to two groups: Group 1 (n = 70) was provided with video clips AO, whereas Group 2 (n = 71) was provided with prosection AO, the use of cadaveric specimens dissected by the course instructor. Student self-assessment scores regarding the learning objectives of upper limb anatomy improved significantly in both groups. Academic achievement scores in Group 2 were significantly higher than those in Group 1, although the self-assessment scores were not significantly different between the groups. Additionally, students in Group 2 responded significantly more positively to the statements about perception of the learning experience such as helping them understand the course content and concepts, decreasing anxiety about the dissection course, and participating actively in the dissection. It would seem that the application of prosection as an AO improved academic achievement and increased student engagement and satisfaction. This study will contribute to designing effective AOs and developing a teaching and learning strategy for a gross anatomy dissection course.

Medical students' failure experiences and their related factors.

PURPOSE: A considerable number of medical students drop out due to low academic achievement, and these students have a high probability of repeated failure experiences. This study investigated the personal and academic problems of these students to help develop student support systems. METHODS: First-year (n=146) and second-year (n=119) medical students were asked to complete questionnaires. The questionnaires consisted of personality traits and the students' management of/satisfaction with school life. RESULTS: Students who had already dropped out accounted for 17.4% of the study subjects. The most common reason for dropping out was low academic achievement, and the most difficult part of taking a leave of absence from school was psychological anxiety. The group who dropped out had significantly lower levels of emotional stability, sociability, responsibility, dominance, masculinity, and superiority and more vulnerable mental states compared with those who did not drop out. They also expressed less motivation with regard to medical science and less satisfaction with school life than did the group that did not drop out. Those who dropped out tended not to prepare for exams, and they managed their time ineffectively. They also tried to resolve their difficulties alone and rarely sought help from teachers. CONCLUSION: More intimate student-teacher relationships should be established, and teachers should be encouraged to meet and interact with their students on a regular basis. Additionally, personality inventories should be used to assist in efforts to understand students, especially to identify hidden social and emotional problems.

Analysis of Verbal Interactions in Problem-based Learning.

PURPOSE: Problem-based learning (PBL) is a constructive learning environment that solves ill-structured problems through collaborative learning. The purpose of this study was to analyze the interaction of students and a tutor in a small-group PBL discussion. This study examined how the types of interactions are composed over the meeting. METHODS: Fourteen third-year subjects from Chonnam National University Medical School, Korea formed two tutorial groups. Two tutorial sessions were videotaped and analyzed. All videotapes were transcribed to analyze the interaction type. The criteria of interaction analysis were learning-oriented interaction (exploratory questioning, cumulative reasoning, handling conflicts about the knowledge), procedural interactions, and irrelevant task interactions. RESULTS: Nearly all discourses between tutors and students were learning-oriented interactions. The results showed that students spent more time on cumulative reasoning. In contrast, tutors implemented more exploratory questioning. Little time was spent on handling conflicts about knowledge and procedural and irrelevant/off-task interactions. CONCLUSION: To improve critical thinking and problem-solving competence in PBL, we should consider various efforts to encourage discussion about conflicting knowledge. A PBL tutor training program should be provided to facilitate PBL group discussions.

Comparison of Learning Styles between Medical College Students and Professional Graduate Medical School Students.

PURPOSE: The Professional Graduate Medical School (PGMS) was established in 2003 in South Korea to train doctors that had better humanities and various educational backgrounds. By comparing the learning styles between students of the Medical College (MC) and PGMS, we investigated the characteristics of these students. METHODS: The Kolb Learning Style Inventory (LSI) is used to determine learning preferences. It is composed of 12 statements on concrete experience, reflective observation, abstract conceptualization, and active experimentation. Six hundred nine students from all years of the 2 medical schools completed the Kolb LSI between June 1st and June 30th, 2008 (response rate: 91.4%). RESULTS: MC students preferred Kolb's 'assimilator (56.3%)' and 'diverger (25.6%)', and PGMS students preferred Kolb's 'assimilator (61.2%)' and 'converger (19.3%)'. PGMS students showed a higher preference for abstract conceptualization compared with MC students (adjusted Odds Ratio=2.191; 95% Confidence Interval=1.115~4.306). CONCLUSION: This study showed that the learning styles of PGMS and MC students differed. We can use this result not only in developing curricula and teaching strategies, but also in providing support to students.

Changes of Epistemological Beliefs and Self-regulated Learning in Problem-based Learning.

PURPOSE: Epistemological beliefs (EBs) are fundamental assumptions about the nature of knowledge and learning. Self-regulation (SR) is the ability and willingness to effectively use and monitor cognitive strategies. Problem-based learning (PBL) emphasizes meaningful learning through solving ill-structured problems. PBL, as a constructivist learning environment, affects students' epistemological beliefs (EBs) and self-regulation learning (SRL). The purpose of this study was to investigate the change in EBs and SRL between pre- and post-PBL. METHODS: The subjects were 123 third-year medical students who attended Chonnam National University Medical School (CNUMS), Korea. Participants had to fill out a questionnaire concerning epistemological beliefs and self-regulated learning before and after PBL. RESULTS: Students' EBs about rigid learning was positively changed; however, certainty of knowledge and speed of knowledge acquisition were negatively changed after PBL. Students' SRL related to self-efficacy and self-regulation was significantly improved in PBL. There was no significant change with regard to internal value, cognitive strategy, and anxiety. CONCLUSION: EBs on certainty of knowledge and speed of knowledge acquisition were negatively changed after PBL. This result may be due to other leaning environments besides PBL i.e., the lecture-based objective learning environment of medical school. It is suggested that partial PBL cannot fully change students' EBs to higher levels. Students' SR about self-efficacy and self-regulation was significantly improved in PBL. The characteristics of PBL: small-group discussion and co-operative team activity, as well as students-centered learning environments, facilitate self-efficacy, and self-regulation.