Latent profile analysis of adaptation types and stress among medical students during the COVID-19 pandemic in South Korea.

Objective: This study aimed to identify profile groups based on personality traits and coping strategies exhibited by medical students in the context of COVID-19. Methods: We conducted a cross-sectional survey and latent profile analysis to investigate differences in stressors, psychological distress, and stress levels with academic variables. We collected data online (Google survey form) in November and December 2021. The participants included a total of 260 1st and 2nd year medical students, all completed questionnaires containing the following sections: Big Five Inventory, coping strategies, COVID-19 stressors, Kessler Psychological Distress Scale, and stress level with academic variables. For analysis, a latent profile analysis, ANOVA, and χ2 were used. Results: The results reveal the three following profile groups: adaptive (lowest neuroticism, low mental disengagement), middle-adaptive (moderate neuroticism, low mental disengagement), and maladaptive (highest neuroticism and mental disengagement), respectively comprising 25.0%, 39.2%, and 35.8% of the study sample. There were no statistically significant intergroup differences regarding grade (χ2=3.345, p=0.188) or gender (χ2=1.197, p=0.550). The maladaptive group was strongly associated with perceived stress during the COVID-19 pandemic (p<0.001). Conclusion: These findings highlight the value of considering profile groups when determining whether students require additional support during pandemics.

Changes in self-reflective thinking level in writing and educational needs of medical students: A longitudinal study.

INTRODUCTION: The purpose of this study was to longitudinally examine the change in understanding of the self-reflection method, reflective thinking, and writing attitude and perception. Moreover, we investigated students' educational needs and methods regarding self-reflection. METHODS: The subjects were 117, who were in the pre-medical course in 2017 and were promoted to the medical course in 2019. Questions concerning students' understanding of self-reflection methods, their attitude and perception of reflective writing, and educational needs and methods regarding self-reflection were self-developed. For students' reflective thinking level in writing, we used the approach developed by Galvez-Martin, Bowman, and Morrison and adapted by Kwon. For dada analysis, χ2 test, t-test, frequency analysis was used. RESULTS: We found that students' level of understanding regarding self-reflection methods increases slightly, but not significant (χ2 = 2.238, p>0.05). There was no significant change in the level of reflective thinking in writing (χ2 = 8.003, p>0.05). The students' attitude toward reflective writing decreased in the medical course than in the pre-medical course (t = 3.475, p<0.001). The perception that reflective writing was helpful for individual improvement decreased during the medical course (t = 4.931, p<0.001). The need for self-reflection education increased in the medical course (t = -2.659, p<0.001). They preferred implementation in the first year of the medical course as an instructor-led special lecture. CONCLUSION: Self-reflective ability is not naturally developed as students' progress through grade levels. Educational intervention is needed to help students understand approaches to self-reflection and its importance in enabling them to develop their abilities as well as to participate actively in reflective writing.

Heart Rate Variability-Measured Stress and Academic Achievement in Medical Students.

OBJECTIVES: Stress can affect learning and memory in students. Previous studies on stress in students were conducted mainly through surveys. We investigated how heart rate variability (HRV)-measured stress is related to academic achievement in medical students during clerkship. SUBJECTS AND METHODS: A cross-sectional study was conducted. HRV measurements were performed in 97 third-year medical students during their family medicine clerkship course. Data on written and skilled examination scores of the end of the school year were also collected. We assessed the association between HRV-measured stress and written/skilled examination scores. RESULTS: Written examination scores showed a positive correlation with standard deviation of the normal-to-normal intervals (SDNNs) (r = 0.245, p = -0.016), sympathetic nervous system/parasympathetic nervous system (SNS/PNS) balance (r = 0.218, p = 0.033), and stress index (r = 0.381, p = 0.004). Students with an unhealthy SDNN, a dominant SNS, and a high stress index had higher scores in written examinations than students with a healthy SDNN, a balanced SNS/PNS, and a normal stress index, respectively (p = 0.004, 0.018, and 0.012, respectively). Moreover, skilled examination scores were negatively correlated with BMI (r = -0.249, p = 0.014) and were higher in female students (r = 0.240, p = 0.018). Students with an abnormal autonomic balance diagram (ABD) had a higher score than students with a normal ABD (p = 0.03). CONCLUSIONS: This study shows that medical students with higher stress measured by HRV have higher academic achievement, especially in written examinations. Further studies are needed to confirm the results of this study and to assess the long-term effects of HRV-measured stress on medical students.

Impact of video feedback system on medical students' perception of their clinical performance assessment.

BACKGROUND: Providing feedback on student performance in the clinical performance assessment (CPA) is meaningful in that it helps students understand their strengths and weaknesses. This study compared students' perception of their CPA scores before and after providing personalized video feedback. METHODS: Two identical online surveys of Year 1 medical students (N = 103) that had undergone CPA were conducted to evaluate students' perceptions about their CPA scores before and after video feedback. Students were given their test scores with assessment analysis reports immediately after completing the CPA. Top-scored students from each station agreed to provide their video-recorded performance to the rest of the students. RESULTS: After comparing their performance video and top-scored video at each station, medical students were more aware of their CPA total score, clinical performance examination (CPX) total score, score of each CPX station, section score for the CPX station, history taking section score, physical examination section score, and doctor-patient relationship section score. Moreover, students became more convinced of their own weaknesses from their history taking and patient education section after viewing video feedback than before. CONCLUSION: The use of the video feedback system might help students recognize their CPA results and identify their strengths and weaknesses.

Holistic rubric vs. analytic rubric for measuring clinical performance levels in medical students.

BACKGROUND: Task-specific checklists, holistic rubrics, and analytic rubrics are often used for performance assessments. We examined what factors evaluators consider important in holistic scoring of clinical performance assessment, and compared the usefulness of applying holistic and analytic rubrics respectively, and analytic rubrics in addition to task-specific checklists based on traditional standards. METHODS: We compared the usefulness of a holistic rubric versus an analytic rubric in effectively measuring the clinical skill performances of 126 third-year medical students who participated in a clinical performance assessment conducted by Pusan National University School of Medicine. We conducted a questionnaire survey of 37 evaluators who used all three evaluation methods-holistic rubric, analytic rubric, and task-specific checklist-for each student. The relationship between the scores on the three evaluation methods was analyzed using Pearson's correlation. Inter-rater agreement was analyzed by Kappa index. The effect of holistic and analytic rubric scores on the task-specific checklist score was analyzed using multiple regression analysis. RESULTS: Evaluators perceived accuracy and proficiency to be major factors in objective structured clinical examinations evaluation, and history taking and physical examination to be major factors in clinical performance examinations evaluation. Holistic rubric scores were highly related to the scores of the task-specific checklist and analytic rubric. Relatively low agreement was found in clinical performance examinations compared to objective structured clinical examinations. Meanwhile, the holistic and analytic rubric scores explained 59.1% of the task-specific checklist score in objective structured clinical examinations and 51.6% in clinical performance examinations. CONCLUSION: The results show the usefulness of holistic and analytic rubrics in clinical performance assessment, which can be used in conjunction with task-specific checklists for more efficient evaluation.

Effects of micro- and subtle-expression reading skill training in medical students: A randomized trial.

OBJECTIVE: to investigate the effectiveness of the Micro Expression Training Tool (METT) and the Subtle Expression Training Tool (SETT) to help improve the non-verbal communication skills of medical students. METHODS: In a randomized controlled trial, all participants were randomly allocated to either a training (n=41) or control group (n=41) and were pre-tested before education with METT and SETT at baseline. Then, training students took second tests after a 1-h class about interpreting micro and subtle expressions and control students took the second tests without the class. RESULTS: METT pre-test scores were positively related with female gender, agreeableness, whereas SETT pre-test scores were negatively related with age and positively related with female gender. Mean METT score increases of 29.3% and mean SETT score increases of 36.2% were observed after training, whereas the control group achieved only a mean METT score increase of 11.0% at second testing. Increases in both test scores in the training group were significantly higher than in the control group. CONCLUSION: METT and SETT are effective, simple tools for improving the micro- and subtle-expression reading skills of medical students. PRACTICE IMPLICATIONS: METT and SETT can be effective for improving the non-verbal communication skills of medical students.

A pilot study on the evaluation of medical student documentation: assessment of SOAP notes.

PURPOSE: The purpose of this study was evaluation of the current status of medical students' documentation of patient medical records. METHODS: We checked the completeness, appropriateness, and accuracy of 95 Subjective-Objective-Assessment-Plan (SOAP) notes documented by third-year medical students who participated in clinical skill tests on December 1, 2014. Students were required to complete the SOAP note within 15 minutes of an standard patient (SP)-encounter with a SP complaining rhinorrhea and warring about meningitis. RESULTS: Of the 95 SOAP notes reviewed, 36.8% were not signed. Only 27.4% documented the patient's symptoms under the Objective component, although all students completed the Subjective notes appropriately. A possible diagnosis was assessed by 94.7% students. Plans were described in 94.7% of the SOAP notes. Over half the students planned workups (56.7%) for diagnosis and treatment (52.6%). Accurate documentation of the symptoms, physical findings, diagnoses, and plans were provided in 78.9%, 9.5%, 62.1%, and 38.0% notes, respectively. CONCLUSION: Our results showed that third-year medical students' SOAP notes were not complete, appropriate, or accurate. The most significant problems with completeness were the omission of students' signatures, and inappropriate documentation of the physical examinations conducted. An education and assessment program for complete and accurate medical recording has to be developed.

[Two-and-a-half year follow-up study of strategy factors in successful learning to predict academic achievements in medical education].

PURPOSE: We performed a two-and-a-half year follow-up study of strategy factors in successful learning to predict academic achievements in medical education. METHODS: Strategy factors in successful learning were identified using a content analysis of open-ended responses from 30 medical students who were ranked in the top 10 of their class. Core words were selected among their responses in each category and the frequency of the words were counted. Then, a factors survey was conducted among year 2 students, before the second semester. Finally, we performed an analysis to assess the association between the factors score and academic achievement for the same students 2.5 years later. RESULTS: The core words were "planning and execution," "daily reviews" in the study schedule category; "focusing in class" and "taking notes" among class-related category; and "lecture notes," "previous exams or papers," and "textbooks" in the primary self-learning resources category. There were associations between the factors scores for study planning and execution, focusing in class, and taking notes and academic achievement, representing the second year second semester credit score, third year written exam scores and fourth year written and skill exam scores. Study planning was only one independent variable to predict fourth year summative written exam scores. CONCLUSION: In a two-and-a-half year follow-up study, associations were founded between academic achievement and the factors scores for study planning and execution, focusing in class, and taking notes. Study planning as only one independent variable is useful for predicting fourth year summative written exam score.

Group counseling for medical students with drop-out experiences.

PURPOSE: The purpose of this research was to describe our group counseling methods for medical students with drop-out experiences. METHODS: Group counseling was offered to 11 medical students with drop-out experiences in their previous second semester. All subjects provided written informed consent before participating and completed a 2-day group counseling program using the Gestalt approach. The self-assertiveness training group counseling program consisted of 6 sessions, each of which lasted 90 minutes. Experience reports by participants after the program and data from semi-structured qualitative interviews were qualitatively analyzed. RESULTS: Program participants reported that they were moderately satisfied with the program regarding its usefulness and helpfulness on self-awareness, understanding, and reminding them of attempts to change behavior. Most students showed heightened levels of sincerity perceptions and positive attitudes in every session. The results demonstrated significant changes in experience in self-esteem, self-recognition, and interpersonal relationships. CONCLUSION: A group counseling program using the Gestalt approach could help medical students with drop-out experiences to adjust with 1 year their juniors, enhance their self-esteem, contribute to their psychological well-being, and prevent student re-failure through effective stress management and improved interpersonal relationships.

Experience of clinical skills assessment in the Busan-Gyeongnam Consortium.

PURPOSE: The purpose of this study is to judge the quality of clinical skills assessment in Busan-Gyeongnam Consortium. METHODS: Fourth grade medical school students (n=350 in 2012 and n=419 in 2013) in the Busan-Gyeongnam Consortium were included in the study. The examination was consisted of 6 clinical performance examination (CPX) and 6 objective structured clinical examination (OSCE) stations. The students were divided into groups to take the exam in 4 sites during 3 days. The overall reliability was estimated by Cronbach alpha coefficient across the stations and the case reliability was by alpha across checklist items. Analysis of variance and between-group variation were used to evaluate the variation of examinee performance across different days and sites. RESULTS: The mean total CPX/OSCE score was 67.0 points. The overall alpha across-stations was 0.66 in 2012 and 0.61 in 2013. The alpha across-items within a station was 0.54 to 0.86 in CPX, 0.51 to 0.92 in OSCE. There was no significant increase in scores between the different days. The mean scores over sites were different in 30 out of 48 stations but between-group variances were under 30%, except 2 cases. CONCLUSION: The overall reliability was below 0.70 and standardization of exam sites was unclear. To improve the quality of exam, case development, item design, training of standardized patients and assessors, and standardization of sites are necessary. Above of all, we need to develop the well-organized matrix to measure the quality of the exam.

Analysis of questioning technique during classes in medical education.

BACKGROUND: Questioning is one of the essential techniques used by lecturers to make lectures more interactive and effective. This study surveyed the perception of questioning techniques by medical school faculty members and analyzed how the questioning technique is used in actual classes. METHODS: Data on the perceptions of the questioning skills used during lectures was collected using a self-questionnaire for faculty members (N = 33) during the second semester of 2008. The questionnaire consisted of 18 items covering the awareness and characteristics of questioning skills. Recorded video tapes were used to observe the faculty members' questioning skills. RESULTS: Most faculty members regarded the questioning technique during classes as being important and expected positive outcomes in terms of the students' participation in class, concentration in class and understanding of the class contents. In the 99 classes analyzed, the median number of questions per class was 1 (0-29). Among them, 40 classes (40.4 %) did not use questioning techniques. The frequency of questioning per lecture was similar regardless of the faculty members' perception. On the other hand, the faculty members perceived that their usual wait time after question was approximately 10 seconds compared to only 2.5 seconds measured from video analysis. More lecture-experienced faculty members tended to ask more questions in class. CONCLUSIONS: There were some discrepancies regarding the questioning technique between the faculty members' perceptions and reality, even though they had positive opinions of the technique. The questioning skills during a lecture need to be emphasized to faculty members.

Differential expression of ghrelin mRNA according to anatomical portions of human stomach.

BACKGROUND/AIMS: The detailed ghrelin distribution on mRNA level in different anatomical portions of adult stomach and its association with plasma ghrelin levels are not yet well established. We investigated the ghrelin mRNA and peptide expression in different anatomical portions of stomach in human adults. METHODOLOGY: Stomach tissue samples were obtained from 16 patients with gastric cancer who underwent total gastrectomy. The normal stomach tissues were taken from the upper (gastric fundus and upper body), middle (gastric middle and lower body) and lower (gastric antrum and pylorus) portions of stomach, respectively. The expression of ghrelin mRNA and peptide in stomach tissue samples were measured using RT-PCR and immunohistochemistry. RESULTS: The ghrelin/actin ratio was 0.78 (range 0-3.38; n=16) at the upper portion, 0.20 (range 0-1.28; n=16) at the middle portion and 0.07 (range 0-0.67; n=16) at the lower portion of the stomach (p=0.001). Ghrelin-positive cells were seen in all parts of the gastric mucosa and were most numerous in the glandular compartment compared to foveolar compartment. Gastric body or fundic mucosa showed ghrelin-positive cells most abundantly as compared to other portions of the gastric mucosa (p<0.001). CONCLUSIONS: Ghrelin mRNA expression and immunoreactivity is highest at the upper portion of the human stomach.

Instructional analysis of lecture video recordings and its application for quality improvement of medical lectures.

PURPOSE: The lecture is a technique for delivering knowledge and information cost-effectively to large medical classes in medical education. The aim of this study was to analyze teaching quality, based on triangle analysis of video recordings of medical lectures, to strengthen teaching competency in medical school. METHODS: The subjects of this study were 13 medical professors who taught 1st- and 2nd-year medical students and agreed to a triangle analysis of video recordings of their lectures. We first performed triangle analysis, which consisted of a professional analysis of video recordings, self-assessment by teaching professors, and feedback from students, and the data were crosschecked by five school consultants for reliability and consistency. RESULTS: Most of the distress that teachers experienced during the lecture occurred in uniform teaching environments, such as larger lecture classes. Larger lectures that primarily used PowerPoint as a medium to deliver information effected poor interaction with students. Other distressing factors in the lecture were personal characteristics and lack of strategic faculty development. CONCLUSION: Triangle analysis of video recordings of medical lectures gives teachers an opportunity and motive to improve teaching quality. Faculty development and various improvement strategies, based on this analysis, are expected to help teachers succeed as effective, efficient, and attractive lecturers while improving the quality of larger lecture classes.

The impact of bladder distension on blood pressure in middle aged women.

BACKGROUND: The purpose of the present study was to investigate the relation between the extent of bladder distention and the rise of blood pressure in middle aged women. METHODS: In a cross-sectional, descriptive observational study, we obtained data from 172 middle aged women at a health promotion center of Pusan National University Hospital. We measured duration of urine-holding as the degree of the extension of bladder distention. Blood pressure was measured twice while holding urine and immediately after urination. Urine holding with full bladder was confirmed by abdominal ultrasound. RESULTS: Difference in systolic blood pressure was 4.2 ± 10.7 (P < 0.001), and that in diastolic blood pressure was 2.8 ± 7.7 mm Hg (P < 0.001) between holding urine and immediately after urination. There was no significant correlation between the urine-holding duration and differences in systolic and diastolic blood pressure. CONCLUSION: Our findings suggest that systolic and diastolic blood pressure is increased by urine-holding at least 3 hours after the last urination in middle aged women. Thus in practice, blood pressure should be measured after the bladder is emptied.

Effects of differences in problem-based learning course length on academic motivation and self-directed learning readiness in medical school students.

PURPOSE: Problem-based learning (PBL) is an educational approach in which complex authentic problems serve as the context and stimulus for learning. PBL is designed to encourage active participation during learning. The goal of this study was to study the effects of PBL on academic motivation and self-directed learning readiness in medical school students. METHODS: The subjects of this study were 190 students in the 1st and 2nd grade of medical school. The period of the PBL course was two weeks for Year 1 and five weeks for Year 2 students. Students completed one module over one week. Academic motivation tests and self-directed learning readiness tests were performed before and after the PBL course. The differences between the two groups were analyzed using paired t-test and repeated measures MANCOVA. RESULTS: PBL had positive effects on academic self-efficacy (self-control efficacy, task-level preference) and academic failure tolerance (behavior, task-difficulty preference) as academic motivation. PBL had a mildly positive effect on self-directed learning readiness. In addition, the five-week PBL course had greater positive effects on academic motivation than the two-week course but not with regard to self-directed learning readiness. CONCLUSION: Medical students engage in academic motivation and self-directed learning readiness during PBL, suggesting that the five-week PBL course has greater positive effects than the two-week course. Future studies are needed to confirm the most effective periods of PBL.

[A case of severe hemolytic disease of the newborn due to anti-Dia antibody].

Here we report a severe case of hemolytic anemia of the newborn with kernicterus caused by anti-Di(a) antibody. A full term male infant was transferred due to hyperbilirubinemia on the third day of life. Despite single phototherapy, the baby's total bilirubin had elevated to 30.1 mg/dL. After exchange transfusion, total bilirubin decreased to 11.45 mg/dL. The direct antiglobulin test on the infant's red cells was positive. The maternal and infant's sera showed a negative reaction in routine antibody detection tests, but were positive in Di(a) panel cells. The frequency of the Di(a) antigen among the Korean population is estimated to be 6.4-14.5%. Anti-Di(a) antibody could cause a hemolytic reaction against transfusion or hemolytic disease of the newborn. We suggest the need for reagent red blood cell panels to include Di(a) antigen positive cells in antibody identification test for Korean.