Exploring the responses of preclinical medical students and professors to flipped learning for the development of clinical reasoning.

PURPOSE: This study developed and implemented case-based flipped learning using illness script worksheets and investigated the responses of preclinical students and professors to the intervention in terms of its effectiveness, design, and implementation. METHODS: The study was conducted at a medical school in Korea, where the "clinical reasoning method" course, originally a lecture-oriented course, was redesigned into a flipped learning. In total, 42 second-year medical students and 15 professors participated in this course. After the class, online surveys were conducted, and a focus group interview was held with seven students to explore the students' experiences in more detail. RESULTS: In total, 37 students and seven professors participated in the survey. The mean score for all items is 3.12/4 for the student survey and 3.43/4 for the professor survey. The focus group interview results were categorized as the beneficial aspects and challenges for the development of clinical reasoning. CONCLUSION: The findings indicated that their responses to the intervention were generally positive, and it is thought to be an effective instructional method for fostering clinical reasoning skills in preclinical medical students.

Fostering clinical reasoning ability in preclinical students through an illness script worksheet approach in flipped learning: a quasi-experimental study.

BACKGROUND: The consensus that clinical reasoning should be explicitly addressed throughout medical training is increasing; however, studies on specific teaching methods, particularly, for preclinical students, are lacking. This study investigated the effects of an illness script worksheet approach in flipped learning on the development of clinical reasoning abilities in preclinical students. It also explored whether the impact of this intervention differed depending on clinical reasoning ability after dividing the students into high and low groups based on their pre-diagnostic thinking inventory (DTI) scores. METHODS: This study used a one-group pre-post test design and convenience sampling. Forty-two second-year medical students were invited to participate in this study. The course, "clinical reasoning method," was redesigned as an illness script worksheet approach in flipped learning. The course was an eight-week long program. The students met once or twice per week with a different professor each time and engaged with 15 clinical cases in small groups in one classroom. Each time, one professor facilitated seven groups in a single classroom. The effectiveness of the intervention was measured using DTI before and after the intervention. A learning experience survey was conducted with post-DTI assessment. RESULTS: Thirty-six students participated in the survey and their data were analyzed. The mean pre-DTI score was 170.4, and the mean post-DTI score was 185.2, indicating an 8.68% increase (p < .001). Significant differences were also found in both high and low groups between the pre- and post-DTI assessments. However, the low group improved much more than the high group and exhibited a significant increase in one of the DTI subscales as well. The overall average score on the learning experience survey was 3.11 out of 4. CONCLUSION: The findings indicated that the intervention was an effective instructional method for the development of clinical reasoning in preclinical students and was more beneficial for students with a low level of clinical reasoning ability. This study demonstrated that the intervention can be a feasible and scalable method to effectively and efficiently train clinical reasoning in preclinical students in a classroom.

Validating the Korean shorter Diagnostic Thinking Inventory in medical education: a pilot study.

PURPOSE: Developing clinical reasoning across the medical curriculum requires valid, reliable, and feasible assessment tools. However, few validated tools are available for the convenient and efficient quantification of clinical reasoning. Thus, this study aimed to create a shorter version of the Diagnostic Thinking Inventory (DTI) and validate it in the Korean medical education context (DTI-SK). METHODS: The DTI-SK was constructed using content validity and a translation and back-translation process. It comprises two subcategories and 14 items. Its validity and reliability were explored using exploratory and confirmatory factor analyses, mean comparisons of four medical student groups (med 1 to med 4), and internal consistency using Cronbach's α. Two hundred medical students were invited to participate through email, and the survey was administered for 2 weeks. RESULTS: Data from 136 students were analyzed. Exploratory factor analysis revealed two factors with eigenvalues greater than 1.0 and they together explained 54.65% of the variance. Confirmatory factor analysis demonstrated that the model had acceptable level of fit and convergent validity. Discriminant validity was confirmed using heterotrait-monotrait criterion. Group comparisons demonstrated that the med 4 students showed significantly higher scores than the med 1 and 2 students. The inventory exhibited strong internal consistency for all items (Cronbach's α=0.906). CONCLUSION: The findings indicated that the DTI-SK is a reliable and valid tool for measuring medical students' clinical reasoning in the context of Korean medical education.

Critical e-learning quality factors affecting student satisfaction in a Korean medical school.

PURPOSE: This research investigated the critical factors that affect the e-learning quality. The student satisfaction model with the five factors such as content, system, learner, instructor and interaction was proposed and empirically examined. It also investigated the relationship between the interaction and other constructs. METHODS: This study used a cross sectional survey design, and convenience sampling. To examine the critical factors and their relationship, a survey of 28 items was developed based on previous studies and sent out through a learning management system to all the students (n=250) enrolled in the pre-med 1 to the medicine 3 in one medical school in Korea. The medical school delivered all the courses online due to the coronavirus disease 2019 pandemic. The collected data (n=209, 83.6%) were analyzed through structural equation modeling by using IBM AMOS ver. 26.0 and IBM SPSS ver. 26.0 (IBM Corp., Armonk, USA). RESULTS: The determinants of e-learning student satisfaction were system, learner, instructor, and interaction qualities, which together explained 72.6% of the variance of student satisfaction and the determinants of e-learning interaction quality were content and system qualities, which together explained 62.9% of the variance of interaction quality. CONCLUSION: The results of this study presented practical guidelines to improve e-learning quality in terms of student satisfaction in medical education contexts. The results indicated that more efforts should be directed toward improving interaction features such as interactive teaching styles, collaborative activities, providing instructors and learners with proper training for e-learning prior to e-learning and a quality of contents, and upgrading e-learning system for better performance and service.

Medical students' self-directed learning skills during online learning amid the COVID-19 pandemic in a Korean medical school.

PURPOSE: This study examined medical students' self-directed learning skills in online learning contexts, and whether there were any differences among the student groups (from pre-medical program year 1 to medical program year 2) amid the coronavirus disease 2019 (COVID-19) pandemic. It also explored the components of self-directed learning skills influencing their perceived learnring performance and satisfaction in online learning contexts. METHODS: This study used a cross-sectional survey design and convenience sampling. It was conducted in a Korean medical school, which delivered all courses online because of the COVID-19 pandemic. The self-directed learning skill survey, which included student satisfaction and perceived learning performance items, was disseminated over two weeks through email to the participants. The collected data were analyzed through descriptive statistics, analysis of variance, and multiple regressions. RESULTS: The survey response rate was 70% (140/200). The overall mean of self-directed learning skills was 3.85. Students in medical year 2 showed the highest score (4.15), while students in medical year 1 showed the lowest score (3.69). The learning plan category score (3.74) was the lowest among the three categories. The pre-medical program year 1 students showed the lowest score in the perceived learning performance (3.16), and only the learning plan category impacted student satisfaction (t=2.605, p=0.041) and perceived learning performance (t=3.022, p=0.003). CONCLUSION: When designing online learning environments, it is imperative to provide features to help students set learning goals and search diverse online learning resources. In addition, it is an effective strategy to provide the students in medical program year 1 with self-directed learning skills training or support for successful online learning.

Strategies for developing pre-clinical medical students' clinical reasoning based on illness script formation: a systematic review.

Clinical reasoning training in the pre-clinical phase has recently been considered important; however, when it comes to specific instructional methods for pre-clinical students, much is unknown. Thus, the aim of this review is to explore learning and teaching methods for pre-clinical students' clinical reasoning development based on illness script formation, their results, and strategies. A systematic review was conducted in accordance with the guidelines of the Association for Medical Education in Europe. The literature search was performed using the Cochrane Library, PubMed, EMBASE, Web of Science, and ERIC databases based on keywords, including "illness script*" AND ("medical student*" OR pre-clinical OR undergraduate). Then, 10 studies among the 91 studies were included in the final analysis. The quality of the selected studies was also appraised using the Medical Education Research Study Quality Instrument. Diverse teaching and learning methods were used to support the integration of biomedical and clinical knowledge working with patient cases, and their effects were assessed through diverse methods, including illness script richness and maturity, to learner responses. The effects of these interventions were effective in terms of the clinical reasoning development of pre-clinical students. Learning and teaching strategies were synthesized and described. This review found that explicit attempts to promote illness script formation with a structured program rather than informal training lead to positive results, and such formal clinical reasoning programs can provide smooth transition from pre-clinical to clinical experience.

Exploring medical educators' readiness and the priority of their educational needs for online teaching.

PURPOSE: This study investigated medical educators' readiness for online teaching by exploring their perceived ability and importance of online teaching competencies and identified the highest priority of their educational needs. METHODS: In this study, 144 medical education faculty members from a university were invited to participate. The faculty online teaching readiness scale was virtually distributed at the end of the spring semester of 2020 and 38 faculty members responded for 2 weeks. The collected data were analyzed with descriptive statistics, paired t-tests, Borich Needs Assessment, and the Locus for Focus model. RESULTS: The overall average perceived ability was 2.76, while the overall average perceived importance was 3.36. The course design and the technical competency categories showed the highest and lowest educational needs, respectively. Five competencies were given the highest priority of educational needs. CONCLUSION: The results revealed that the medical educators are not ready for online teaching; thus, urgent educational needs for online teaching competencies exist.

The role of collective efficacy and co-regulation in medical students' performance in small group contexts.

PURPOSE: This study investigated the role of collective efficacy and co-regulation in terms of students' performance during small group projects in a medical research program. The effect of collective efficacy in student performance was expected to be mediated by co-regulation. METHODS: A total of 50 students who enrolled in a medical research program worked on their medical research project in small groups over a period of 9 weeks. After they had submitted their final research project reports as groups at the end of the course, the collective efficacy and co-regulation surveys were conducted online. RESULTS: The mediation model was significant and explained 26.61% of the variance in student performance. The total effect of collective efficacy on student performance was significant and the indirect effect through co-regulation was also significant. CONCLUSION: These results suggest that collective efficacy influenced student performance through co-regulation in group learning contexts. Considering the fact that more and more collaborative learning now occurs in medical education, the result of this study can provide significant insights for enhancing students' performance in small group contexts.

Course-based research experience of undergraduate medical students through project-based learning.

PURPOSE: This study aimed to design and implement an introductory-level course-based research experience (CRE) through project-based learning (PBL) for undergraduate medical students and investigate their learning experience and research skill development, with the ultimate objective of exploring whether CRE can be effectively utilized for undergraduate research experience. METHODS: This study included 40 second-year premedical students enrolled in "Scientific thinking and medical research," which was developed as an introductory-level CRE through PBL. It was a three-credit course and the students met twice a week for one semester. The students' learning experiences were examined with a 15-item survey including three open-ended questions, while their research skills were assessed through the research reports using a research skill rubric at the end of the course. RESULTS: The findings showed that the students perceived the course structure as appropriate and helpful. They also considered the group work experience to be positive and productive. Learner satisfaction items also earned positive responses in general. Regarding the research skill assessment, the mean value of the research skill scores of each group was 19.11 out of 27 and the mean value of each research skill score was 2.12 out of 3. CONCLUSION: Overall, the students were satisfied with their research experience, and their research skills were developed, suggesting that this introductory CRE through PBL can be effectively and efficiently utilized for undergraduate research experience.

An analysis of medical students' reflective essays in problem-based learning.

PURPOSE: This study aimed to explore students' learning experience in problem-based learning (PBL) particularly in terms of what they learned and how they learned in one Korean medical school by analyzing their reflective essays with qualitative research methods. METHODS: This study included 44 first-year medical students. They took three consecutive PBL courses and wrote reflective essays 3 times anonymously on the last day of each course. Their reflective essays were analyzed using an inductive content analysis method. RESULTS: The coding process yielded 16 sub-categories and these categories were grouped into six categories according to the distinctive characteristics of PBL learning experience: integrated knowledge base, clinical problem solving, collaboration, intrinsic motivation, self-directed learning, and professional attitude. Among these categories, integrated knowledge base (34.68%) and professional attitude (2.31%) were the categories mentioned most and least frequently. CONCLUSION: The findings of this study provide an overall understanding of the learning experience of Korean medical students during PBL in terms of what they learned and how they learned with rich descriptive commentaries from their perspectives as well as several thoughtful insights to help develop instructional strategies to enhance the effectiveness of PBL.

[Needs assessment for developing teaching competencies of medical educators].

PURPOSE: This study conducted a needs assessment for developing teaching competencies of medical educators by assessing their perceived ability to perform teaching competencies as well as their perceived importance of these competencies. Additionally, this study examined whether there were any differences in needs assessments scores among three faculty groups. METHODS: Hundred and eighteen professors from Dong-A University College of Medicine were surveyed, and the data from 44 professors who answered all the questions were analyzed using IBM SPSS 21. The needs assessment tool measured participants' perceived ability to perform teaching competencies and perceived importance of these competencies. The Borich formula was used to calculate needs assessment scores. RESULTS: The most urgent needs for faculty development were identified for the teaching competencies of "diagnosis and reflection," followed by "test and feedback," and "facilitation." Additionally, two, out of 51, items with the highest needs assessment scores were "developing a thorough course syllabus" and "introducing students to the course syllabus on the first day of class." The assistant professor group scored significantly higher on educational needs related to "facilitation," "affection and concern for students," and "respect for diversity" competencies than the professor group. Furthermore, the educational needs scores for all the teaching competencies except "diagnosis and reflection," "global mindset," and "instructional management" were higher for the assistant professor group than the other two faculty groups. CONCLUSION: Thus, the educational needs assessment scores obtained in this study can be used as criteria for designing and developing faculty development programs for medical educators.