Preclinical students' views on medical ethics education: a focus group study in Turkey / Puntos de vista de estudiantes de pre-clínica sobre educación en ética médica: un estudio de grupo focal en Turquía / A perspectiva dos estudantes pré-clínicos sobre o ensino da ética médica: um estudo de grupo focal na Turquia

Abstract: 18. Aim: We aimed to receive the opinions of the preclinical medical students on medical ethics education, and to present some suggestions for the education program. Methods: Focus group discussions were held with third-grade medical students. The analyses were implemented using Creswell's six-step qualitative data analysis. Results: During the data analysis, themes with the following titles were identified: necessity of the education, content, education methods, assessment, participation, contribution of the education, moving to clinical training and suggestions. Discussion: The students stated that the discussions on movies/books/case-based scenarios are more useful than lectures. Although they believed that student assessment was necessary for the medical ethics education, they had negative attitudes towards Multiple Choice Questions. At the stage of moving to the clinical training, their feelings and thoughts about the learning outcomes they would gain from ethical education were contradictory. Conclusion: Each theme and code obtained from the students' expressions may contribute to improving medical ethics education for all institutions. Besides student education, it is also necessary the faculty development programs on medical ethics education for clinical teachers. Additionally, further studies can be conducted on the actions that need to be taken to help students internalize the ethical issues and feel the need of learning more.

Resumen: 22. Nuestro objetivo consistió en recibir las opiniones de estudiantes de medicina en pre-clínica sobre educación en ética médica y presentar algunas sugerencias para el programa de educación. Métodos: Se mantuvo discusiones de grupo focal con estudiantes de medicina de tercer grado. Se implementó el análisis cualitativo de datos de seis pasos de Creswell. Resultados: Mediante el análisis de datos, se identificaron los siguientes temas: necesidad de la educación, contenido, métodos de educación, evaluación, participación, contribución de la educación, el paso a formación clínica y sugerencias. Discusión: Los estudiantes consideraron que las discusiones sobre películas/libros/escenarios de casos eran más útiles que las clases dictadas. Aunque pensaban que la evaluación de los estudiantes era necesaria para la educación en ética médica, no valoraron positivamente las pruebas de preguntas con respuesta múltiple. En el paso a la formación clínica, sus sentimientos y pensamientos sobre los resultados del aprendizaje en educación ética eran contradictorios. Conclusión: Cada tema y código obtenido de las propuestas de los estudiantes puede contribuir a mejorar la educación en ética médica en las instituciones. Además de la educación, también es necesario desarrollar programas sobre educación ética médica para los profesores clínicos. Además, se pueden realizar más estudios sobre las acciones que se necesitan tomar para ayudar a los estudiantes a internalizar los temas éticos y sentir la necesidad de aprender más.

Resumo: 26. Objetivo: tivemos como objetivo coletar as opiniões dos estudantes pré-clínicos de medicina no ensino da ética médica e apresentar algumas sugestões para o programa de ensino. Métodos: foram realizadas discussões em grupos focais com estudantes do 3º período de medicina. As análises foram implementadas usando o método qualitativo de seis etapas de Creswell. Resultados: Durante a análise de dados, os seguintes temas foram identificados: a necessidade da educação, conteúdo, métodos de ensino, avaliação, participação, contribuição da educação, transição para o treinamento clínico e sugestões. Discussão: Os alunos concluíram que as discussões sobre filmes/livros/estudos de caso são mais úteis que aulas expositivas. Embora eles acreditassem que a avaliação de alunos era necessária para o ensino da ética médica, eles tinham atitudes negativas em relação a questões de múltipla escolha. Na fase de transição para o treinamento clínico, seus sentimentos e pensamentos sobre os resultados da aprendizagem, que eles obteriam com o ensino da ética eram contraditórios. Conclusão: Cada tema e código obtidos das opiniões dos alunos podem contribuir para melhorar o ensino da ética médica para todas as instituições. Além do ensino dirigido ao aluno, é necessário que haja também programas de desenvolvimento do corpo docente acerca da educação de ética médica. Ademais, mais estudos podem ser realizados sobre as ações que precisam ser tomadas para ajudar os alunos a interiorizar as questões éticas e sentir a necessidade de aprender mais a respeito.

PRECLINICAL STUDENTS' VIEWS ON MEDICAL ETHICS EDUCATION: A FOCUS GROUP STUDY IN TURKEY.

AIM: We aimed to receive the opinions of the preclinical medical students on medical ethics education, and to present some suggestions for the education program. METHODS: Focus group discussions were held with third-grade medical students. The analyses were implemented using Creswell's six-step qualitative data analysis. RESULTS: During the data analysis, themes with the following titles were identified: necessity of the education, content, education methods, assessment, participation, contribution of the education, moving to clinical training and suggestions. DISCUSSION: The students stated that the discussions on movies/books/case-based scenarios are more useful than lectures. Although they believed that student assessment was necessary for the medical ethics education, they had negative attitudes towards Multiple Choice Questions. At the stage of moving to the clinical training, their feelings and thoughts about the learning outcomes they would gain from ethical education were contradictory. CONCLUSION: Each theme and code obtained from the students' expressions may contribute to improving medical ethics education for all institutions. Besides student education, it is also necessary that the faculty develop programs on medical ethics education for clinical teachers. Additionally, further studies can be conducted on the actions that need to be taken to help students internalize the ethical issues and feel the need of learning more.

Nuestro objetivo consistió en recibir las opiniones de estudiantes de medicina en pre-clínica sobre educación en ética médica y presentar algunas sugerencias para el programa de educación. Métodos: Se mantuvo discusiones de grupo focal con estudiantes de medicina de tercer grado. Se implementó el análisis cualitativo de datos de seis pasos de Creswell. Resultados: Mediante el análisis de datos, se identificaron los siguientes temas: necesidad de la educación, contenido, métodos de educación, evaluación, participación, contribución de la educación, el paso a formación clínica y sugerencias. Discusión: Los estudiantes consideraron que las discusiones sobre películas/libros/escenarios de casos eran más útiles que las clases dictadas. Aunque pensaban que la evaluación de los estudiantes era necesaria para la educación en ética médica, no valoraron positivamente las pruebas de preguntas con respuesta múltiple. En el paso a la formación clínica, sus sentimientos y pensamientos sobre los resultados del aprendizaje en educación ética eran contradictorios. Conclusión: Cada tema y código obtenido de las propuestas de los estudiantes puede contribuir a mejorar la educación en ética médica en las instituciones. Además de la educación, también es necesario desarrollar programas sobre educación ética médica para los profesores clínicos. Además, se pueden realizar más estudios sobre las acciones que se necesitan tomar para ayudar a los estudiantes a internalizar los temas éticos y sentir la necesidad de aprender más.

Objetivo: Coletar as opiniões dos estudantes pré-clínicos de medicina no ensino da ética médica e apresentar algumas sugestões para o programa de ensino. Métodos: foram realizadas discussões em grupos focais com estudantes do 3° período de medicina. As análises foram implementadas usando o método qualitativo de seis etapas de Creswell. Resultados: Durante a análise de dados, os seguintes temas foram identificados: a necessidade da educação, conteúdo, métodos de ensino, avaliação, participação, contribuição da educação, transição para o treinamento clínico e sugestões. Discussão: Os alunos concluíram que as discussões sobre filmes/livros/estudos de caso são mais úteis que aulas expositivas. Embora eles acreditassem que a avaliação de alunos era necessária para o ensino da ética médica, eles tinham atitudes negativas em relação a questões de múltipla escolha. Na fase de transição para o treinamento clínico, seus sentimentos e pensamentos sobre os resultados da aprendizagem, que eles obteriam com o ensino da ética eram contraditórios. Conclusão: Cada tema e código obtidos das opiniões dos alunos podem contribuir para melhorar o ensino da ética médica para todas as instituições. Além do ensino dirigido ao aluno, é necessário que haja também programas de desenvolvimento do corpo docente acerca da educação de ética médica. Ademais, mais estudos podem ser realizados sobre as ações que precisam ser tomadas para ajudar os alunos a interiorizar as questões éticas e sentir a necessidade de aprender mais a respeito.

Exposure of Students to Emotional and Physical Violence in the School Environment.

INTRODUCTION: While peer abuse or physical violence in school is emphasized more, the physical and emotional violence caused by school staff has been emphasized less. The purpose of this study was to investigate the variables related to emotional and physical violence that students are exposed to in the school environment. METHODS: This cross-sectional and descriptive study was conducted by applying a questionnaire to 434 fifth-grade students receiving education in the primary schools in Konak district of Izmir province. Being prepared by the researchers of this study, the questionnaire consisted of questions about the socio-demographic features of the child and the family, the place where the child has been raised, family income, average grade, and the emotional and physical violence of teachers, parents, and peers s/he has been exposed to within the last year. The Chi-square test, Mann-Whitney U test, and logistic regression analysis were used for statistical analyses. RESULTS: The study group consisted of 214 (49.3%) female and 220 (50.7%) male students. Students reported that they were exposed to at least one type of emotional violence from 59.4% of teachers, 52.8% of parents, and 61.8% of children at school; they were exposed to at least one type of physical violence from 42.9% of teachers, 33.6% of parents, and 24.9% of children at school. While the rate of encountering with the beating of another child was 53%, the rate of watching this in television/cinema was 52.8%. Regarding exposure to at least one type of violence, males were found to be significantly more exposed to emotional and physical violence from male teachers, female teachers, and fathers and physical violence from children at school. The factors regarding the exposure to emotional and physical violence by teachers were evaluated using logistic regression analysis, and it was determined that the physical violence from teachers, emotional violence from children in school, and emotional violence from parents could predict the emotional violence from teachers. For males, physical violence from children in school and emotional violence from teachers could predict the physical violence from teachers. CONCLUSION: In this study, the determination of the tendency of togetherness of different types of violence applied to students from different people groups like teachers, parents, and children in school makes us think about the possibility of common risk factors in terms of violence exposure. The risk factors determined in this study may guide us in planning protective interventions aimed at violence.

Electronic acquisition of OSCE performance using tablets.

BACKGROUND: Objective Structured Clinical Examinations (OSCEs) often involve a considerable amount of resources in terms of materials and organization since the scores are often recorded on paper. Computer-assisted administration is an alternative with which the need for material resources can be reduced. In particular, the use of tablets seems sensible because these are easy to transport and flexible to use. AIM: User acceptance concerning the use of tablets during OSCEs has not yet been extensively investigated. The aim of this study was to evaluate tablet-based OSCEs from the perspective of the user (examiner) and the student examinee. METHOD: For two OSCEs in Internal Medicine at the University of Heidelberg, user acceptance was analyzed regarding tablet-based administration (satisfaction with functionality) and the subjective amount of effort as perceived by the examiners. Standardized questionnaires and semi-standardized interviews were conducted (complete survey of all participating examiners). In addition, for one OSCE, the subjective evaluation of this mode of assessment was gathered from a random sample of participating students in semi-standardized interviews. RESULTS: Overall, the examiners were very satisfied with using tablets during the assessment. The subjective amount of effort to use the tablet was found on average to be "hardly difficult". The examiners identified the advantages of this mode of administration as being in particular the ease of use and low rate of error. During the interviews of the examinees, acceptance for the use of tablets during the assessment was also detected. DISCUSSION: Overall, it was found that the use of tablets during OSCEs was well accepted by both examiners and examinees. We expect that this mode of assessment also offers advantages regarding assessment documentation, use of resources, and rate of error in comparison with paper-based assessments; all of these aspects should be followed up on in further studies.

The reliability of the pass/fail decision for assessments comprised of multiple components.

OBJECTIVE: The decision having the most serious consequences for a student taking an assessment is the one to pass or fail that student. For this reason, the reliability of the pass/fail decision must be determined for high quality assessments, just as the measurement reliability of the point values. Assessments in a particular subject (graded course credit) are often composed of multiple components that must be passed independently of each other. When "conjunctively" combining separate pass/fail decisions, as with other complex decision rules for passing, adequate methods of analysis are necessary for estimating the accuracy and consistency of these classifications. To date, very few papers have addressed this issue; a generally applicable procedure was published by Douglas and Mislevy in 2010. Using the example of an assessment comprised of several parts that must be passed separately, this study analyzes the reliability underlying the decision to pass or fail students and discusses the impact of an improved method for identifying those who do not fulfill the minimum requirements. METHOD: The accuracy and consistency of the decision to pass or fail an examinee in the subject cluster Internal Medicine/General Medicine/Clinical Chemistry at the University of Heidelberg's Faculty of Medicine was investigated. This cluster requires students to separately pass three components (two written exams and an OSCE), whereby students may reattempt to pass each component twice. Our analysis was carried out using the method described by Douglas and Mislevy. RESULTS: Frequently, when complex logical connections exist between the individual pass/fail decisions in the case of low failure rates, only a very low reliability for the overall decision to grant graded course credit can be achieved, even if high reliabilities exist for the various components. For the example analyzed here, the classification accuracy and consistency when conjunctively combining the three individual parts is relatively low with κ=0.49 or κ=0.47, despite the good reliability of over 0.75 for each of the three components. The option to repeat each component twice leads to a situation in which only about half of the candidates who do not satisfy the minimum requirements would fail the overall assessment, while the other half is able to continue their studies despite having deficient knowledge and skills. CONCLUSION: The method put forth by Douglas and Mislevy allows the analysis of the decision accuracy and consistency for complex combinations of scores from different components. Even in the case of highly reliable components, it is not necessarily so that a reliable pass/fail decision has been reached - for instance in the case of low failure rates. Assessments must be administered with the explicit goal of identifying examinees that do not fulfill the minimum requirements.

Development of a competency-based formative progress test with student-generated MCQs: Results from a multi-centre pilot study.

INTRODUCTION: Progress tests provide students feedback on their level of proficiency over the course of their medical studies. Peer-assisted learning and competency-based education have become increasingly important in medical education. Although progress tests have been proven to be useful as a longitudinal feedback instrument, there are currently no progress tests that have been created in cooperation with students or that focus on competency in medical education. In this study, we investigated the extent to which students can be included in the development of a progress test and demonstrated that aspects of knowledge related to competency can be represented on a competency-based progress test. METHODS: A two-dimensional blueprint for 144 multiple-choice questions (MCQs) covering groups of medical subjects and groups of competency areas was generated by three expert groups for developing the competency-based progress test. A total of 31 students from seven medical schools in Germany actively participated in this exercise. After completing an intensive and comprehensive training programme, the students generated and reviewed the test questions for the competency-based progress test using a separate platform of the ItemManagementSystem (IMS). This test was administered as a formative test to 469 students in a pilot study in November 2013 at eight medical schools in Germany. The scores were analysed for the overall test and differentiated according to the subject groups and competency areas. RESULTS: A pool of more than 200 MCQs was compiled by the students for pilot use, of which 118 student-generated MCQs were used in the progress test. University instructors supplemented this pool with 26 MCQs, which primarily addressed the area of scientific skills. The post-review showed that student-generated MCQs were of high quality with regard to test statistic criteria and content. Overall, the progress test displayed a very high reliability. When the academic years were compared, the progress test mapped out over the course of study not only by the overall test but also in terms of the subject groups and competency areas. OUTLOOK: Further development in cooperation with students will be continued. Focus will be on compiling additional questions and test formats that can represent competency at a higher skill level, such as key feature questions, situational judgement test questions and OSCE. In addition, the feedback formats will be successively expanded. The intention is also to offer the formative competency-based progress test online.

Sexual attitudes, behaviour changes and opinions of interns in Izmir, Turkey.

OBJECTIVES: To evaluate sexual attitudes, behaviour and opinions of students at the end of their medical education studies in Izmir, Turkey, and compare findings with the results of the study carried out when they were first-year students. METHODS: A cross-sectional and longitudinal study, with data collected via a questionnaire. RESULTS: 'Friends' were most often mentioned as the source of their personal sexual information by students on both occasions. Use of the 'internet' increased significantly during the five years. Pornography and health professionals/specialists' also gained in importance but remained among the less frequently used sources of information. The most frequent factor affecting sexual attitudes and behaviour for both years was 'my own desire and values'. Most (74.8%) interns had taken only a few sexual health histories and 16.5% never; 35% believed their education would enable them to take one. Nearly half (48.5%) said being a medical student changed their opinions on sexuality and 25.7% said they changed their behaviour. DISCUSSION: Although changes were observed in sexual attitudes, behaviour and opinions between the two questionnaires many problems still exist. This study may add to the improvement of medical education regarding sexual health education and its practices.

An example of program evaluation project in undergraduate medical education.

Revisions to existing program evaluation approaches of the Dokuz Eylul University School of Medicine (DEUSM) were made by the Medical Education Department in June 2005. After considering several evaluation models, a mixed evaluation model was developed to meet institutional needs. The general program evaluation plan was structured as areas of inquiry under the three main program evaluation questions: what are the effects of the educational program on students and graduates, what are the effects of the educational program on trainers, and is the educational program being implemented as planned. The School's first report made through its new program evaluation approach was prepared in July 2006, leading to important revisions to the educational program. This article presents DEUSM's project to revise its program evaluation approach and briefly discusses its early implementation.