Does group cohesion foster self-directed learning for medical students? A longitudinal study.

BACKGROUND: The importance of self-directed learning (SDL) and collaborative learning has been emphasized in medical education. This study examined if there were changes in the pattern of SDL and group cohesion from the time of admission to medical school under the criterion-referenced grading system, increased group activities, and interaction of medical education curriculum. Second, it was examined whether group cohesion influences self-directed learning. METHODS: The participants were 106 medical students (71 males, 35 females) who enrolled in Yonsei University College of Medicine in Seoul, South Korea in March 2014. They were asked to complete a Korean version of the self-directed learning readiness scale (SDLRS) and group cohesion scale (GCS) at the end of each semester for three years. A repeated measures ANOVA and a correlation and regression analysis were conducted. RESULTS: All the participants completed the questionnaires. There were differences in the SDLRS scores over the three years. A significant increase was observed one year after admission followed by stable scores until the third year. There was a significant increase in GCS scores as students progressed through medical school years. Positive relationships were found between SDLRS and GCS scores, and the regression model predicted 32% variance. CONCLUSIONS: SDLRS and GCS increased as medical school years progressed. In addition, GCS is a significant factor in fostering SDLRS. Medical schools should develop various curriculum activities that enhance group cohesion among medical students, which would in turn promote SDL.

Effects of test item disclosure on medical licensing examination.

In 2012, the National Health Personnel Licensing Examination Board of Korea decided to publicly disclose all test items and answers to satisfy the test takers' right to know and enhance the transparency of tests administered by the government. This study investigated the effects of item disclosure on the medical licensing examination (MLE), examining test taker performance, psychometric characteristics, and factors affecting pass rates. This paper analyzed examinee performance data (n = 20,455) from 41 medical schools who took the MLE before (2009-2011) and after (2012-2014) the item disclosure policy (5548 total items). Changes in passing rates, performance of examinee, difficulty and reliability of the test, and factors affecting pass rate of the medical licensing examination before and after item disclosure were analyzed. In order to identify changes caused by item disclosure in the effects of student and school variables on the passing rate of MLE, Binary Logistic Hierarchical Linear Model was used. There was no significant change in pass rates before and after item disclosure. There was a modest increase in the proportion of test takers in the high-scoring group, following item disclosure. Degree completion status, gender, age of applicants and school mean were significant factors affecting pass rates, regardless of item disclosure. There was no difference between passing rates before and after item disclosure with respect to student- and school-level variables. Despite potential concerns for changes in test and examinee characteristics, empirical findings indicate that there was no significant difference caused by implementing item disclosure.

Perception of medical professionalism among the surgical community in the University of Nairobi: a mixed method study.

BACKGROUND: Professionalism defines the relationship between colleagues, patients and the society as a whole. Furthermore, being a social construct, professionalism is sophisticated to be regarded simply as a single concept across different cultural contexts. This study sought to explore how professionalism is conceptualized by the clinicians, students and patients in a teaching hospital in Kenya. METHODS: A sequential mixed methods study was conducted among clinicians, students and patients at Kenyatta National Hospital on the surgical wards from March 1(st)-December 31(st), 2014. The first phase of the study involved focus group discussions (FGDs) of between 10-12 persons and individual in-depth interviews of senior faculty and patients. Grounded theory method was used for collecting perceptions of participants on professionalism. These views were then coded using Atlas 5.2, allowing the development of a questionnaire that provided the survey tool for the second phase of the study. For the questionnaire, response options utilized a 4-point Likert scale with a range from "strongly agree" to "strongly disagree". Factor analysis was used to analyse the responses to the survey. Internal reliability was determined by Cronbach's α. RESULTS: Sixteen FGDs and 18 in-depth interviews were held with 204 clinicians, students and patients. A further 188 participants completed the questionnaire. Respect was the most frequently mentioned or picked component of professionalism during the interview and survey respectively, with 74.5 % of participants reporting "strongly agree". Factor analysis showed that 3 factors accounted for the majority of the variance in the items analysed; respect in practice, excellence in service and concern for the patient. The Cronbach's α for this analysis was 0.927. CONCLUSION: The study cohort predominantly conceptualizes professionalism as relating to respect between colleagues and toward patients. Respect, being a cultural norm, should form part of the core curriculum of professionalism in order to be relevant for the Kenyan context.

Factors affecting social accountability of medical schools in the Korean context: exploratory factor and multiple regression analyses.

The concept of social accountability of medical schools is becoming increasingly important worldwide, and numerous frameworks and evaluation tools have been developed. This study examined how global concepts work in a specific context by identifying the factors affecting medical schools' social accountability performance in the Korean context. A survey was conducted with 40 current deans of medical schools and 15 medical education experts in Korea to assess their opinions on the implementation of social accountability of medical schools. A questionnaire survey comprising five key factors, including 39 items, was developed based on a literature review. Exploratory factors were analyzed to derive factors affecting social accountability Multiple regression analysis was conducted to determine the importance of each factor in the implementation of social accountability of medical schools. The exploratory factor analysis revealed that eight factors in three areas influenced the implementation of social accountability by medical schools. The hardware (H) area included the declaration of social accountability and physicians, organizations and systems for implementing social accountability, and physical environment and finance. The software (S) area included curriculum design-related social accountability and monitoring and evaluation system. The partner (P) area included the proximity between partners, building partnerships among stakeholders, and interactions between partners. Multiple regression analysis revealed that 'interactions between partners' had the greatest impact on the implementation of social accountability of medical schools. It is a social accountability implementation model that reflects global principles within the Korean context. The HSP model is significant in that individual medical schools can be used in establishing mandated mechanisms for accreditation. Future studies could adapt this model to study standards and indicators in other contexts.

Comparison of competency level of medical, non-medical students and its relevance for admission policy.

PURPOSE: This study aims to analyze the competency of medical students and its relevance for admission policy in medical schools. METHODS: This study examined the competency of 63 medical students from the 6-year program (group A) and 41 medical students from the 4-year program (group B) at Yonsei University using the Korea Collegiate Essential Skills Assessment (KCESA). The competency of groups A and B were compared to the corresponding competency levels of non-medical students (groups C and D). Group C is freshmen and D is senior students in universities. The KCESA is computer-based ability test composed of 228 items. The competency of participants were calculated on a T-scores (mean=50, standard deviation=10) based on KCESA norm-references. We conducted independent t-test for group comparisons of competency levels. RESULTS: There are no differences in competency levels between groups A and B. Compared with the non-medical students (group B), the medical students showed a significantly stronger ability to use resources, information-technology and higher-order thinking. In the comparison between groups B and D, medical students showed lower levels of self-management, interpersonal, and cooperative skills. CONCLUSION: The cognitive ability serves as an important indicator for the decision on admission to a basic medical education program. The efforts should be made to foster the competency that medical students have been found to lack, such as self-management, interpersonal, and cooperative skills. The admission committee should assess the cognitive and non-cognitive competency of applicants in a balanced manner.

Developing the Korean Association of Medical Colleges graduate outcomes of basic medical education based on "the role of Korean doctor, 2014".

The Korean Association of Medical Colleges (KAMC) developed graduate outcomes based on "The role of Korean doctor, 2014" to serve as guidelines regarding outcome-based education in Korea. The working group in this study analyzed 65 competencies proposed in "The role of Korean doctor, 2014" according to the developmental principle that certain outcomes should be demonstrated at the point of entry into the graduate medical education. We established 34 competencies as "preliminary graduate outcomes" (PGOs). The advisory committee consisted of 11 professors, who reviewed the validity of PGOs. Ultimately, a total of 19 "revised graduate outcomes" (RGOs) were selected. We modified the RGOs based on opinions from medical schools and a public hearing. In November 2017, the KAMC announced the "graduate outcomes for basic medical education," which serves as a guide for basic medical education for the 40 medical schools throughout Korea. Medical schools can expand the graduate outcomes according to their educational goals and modify them according to their own context. We believe that graduate outcomes can be a starting point for connecting basic medical education to graduate medical education.

[Perceptions on item disclosure for the Korean medical licensing examination].

PURPOSE: This study analyzed the perceptions of medical students and faculty regarding disclosure of test items on the Korean medical licensing examination. METHODS: I conducted a survey of medical students from medical colleges and professional medical schools nationwide. Responses were analyzed from 718 participants as well as 69 faculty members who participated in creating the medical licensing examination item sets. Data were analyzed using descriptive statistics and the chi-square test. RESULTS: It is important to maintain test quality and to keep the test items unavailable to the public. There are also concerns among students that disclosure of test items would prompt increasing difficulty of test items (48.3%). Further, few students found it desirable to disclose test items regardless of any considerations (28.5%). The professors, who had experience in designing the test items, also expressed their opposition to test item disclosure (60.9%). CONCLUSION: It is desirable not to disclose the test items of the Korean medical licensing examination to the public on the condition that students are provided with a sufficient amount of information regarding the examination. This is so that the exam can appropriately identify candidates with the required qualifications.

Three controversies over item disclosure in medical licensure examinations.

In response to views on public's right to know, there is growing attention to item disclosure - release of items, answer keys, and performance data to the public - in medical licensure examinations and their potential impact on the test's ability to measure competence and select qualified candidates. Recent debates on this issue have sparked legislative action internationally, including South Korea, with prior discussions among North American countries dating over three decades. The purpose of this study is to identify and analyze three issues associated with item disclosure in medical licensure examinations - 1) fairness and validity, 2) impact on passing levels, and 3) utility of item disclosure - by synthesizing existing literature in relation to standards in testing. Historically, the controversy over item disclosure has centered on fairness and validity. Proponents of item disclosure stress test takers' right to know, while opponents argue from a validity perspective. Item disclosure may bias item characteristics, such as difficulty and discrimination, and has consequences on setting passing levels. To date, there has been limited research on the utility of item disclosure for large scale testing. These issues requires ongoing and careful consideration.

Evaluation of the National Train-the-Trainer Program for Hospice and Palliative Care in Korea.

BACKGROUND: To evaluate the effectiveness of the National Train-the-Trainers Program for Hospice and Palliative Care Experts (TTHPC) sponsored by the National Cancer Center of Korea between 2009 and 2012. This program was developed to improve the teaching skills of those in the field of hospice and palliative care (HPC). MATERIALS AND METHODS: Training was offered in eight 1-day sessions between 2009 and 2012. The effect of the program was measured using Kirkpatrick's model of educational outcomes. First, levels 1 and 2 were evaluated immediately after the 1-day program (n=120). In 2012, the level-3 evaluation test was administered to trainers who offered at least one HPC training (n=78) as well as to their trainees (n=537). RESULTS: The level-1 evaluation addressed participant reactions to and satisfaction with the program. Participants (n=120) were generally satisfied with the content, the method, and the overall course (mean range: 3.94-4.46 on a five-point Likert scale). The level-2 evaluation (learning) showed that participants gained knowledge and confidence related to teaching HPC (4.24 vs. 4.00). The level-3 evaluation (behavioral), which assessed trainers' application of teaching skills to HPC, showed that trainees rated the teaching methods of trainers (mean range: 4.03-4.08) more positively than did trainers (p<0.05). Female trainers were more likely than were male trainers to plan sessions in consideration of their trainees' characteristics (4.11 vs. 3.58; p<0.05), and nurse trainers were more likely than physician trainers to use a variety of instructional methods (4.05 vs. 3.36; p<0.05) CONCLUSIONS: We conducted systematic evaluations based on Kirkpatrick's model to assess the effectiveness of our train-the- trainers program. Our educational program was practical, effective, and followed by our HPC experts, who needed guidance to learn and improve their clinical teaching skills.

Five suggestions for future medical education in Korea.

This study is to investigate the historical characteristics of medical education and healthcare environment in Korea and to suggest the desirable direction for future medical education. We draw a consensus through the literature analysis and several debates from the eight experts of medical education. There are several historical characteristics of medical education: medical education as vocational education and training, as a higher education, rapid growth of new medical schools, change to the medical education system, curriculum development, reinforcement of medical humanities, improvement of teaching and evaluation methods, validation of the national health personnel licensing examination, accreditation system for quality assurance, and establishment of specialized medical education division. The changes of health care environment in medical education are development of medical technologies, changes in the structures of the population and diseases, growth of information and communication technology, consumer-centered society, and increased intervention by the third party stakeholder. We propose five suggestions to be made to improve future medical education. They are plan for outcome and competency-based medical education, connection between the undergraduate and graduate medical education, reinforcement of continuous quality improvement of medical education, reorganization of the medical education system and construction of leadership of "academic medicine."

A study on the characteristics of excellent lecturers in medical school.

PURPOSE: This study analyzed the characteristics of excellent lecturers, as perceived by medical students, and identified the teaching competency that lecturers should possess to enhance the quality of medical education in medical school. METHODS: To examine the characteristics of excellent lecturers and teaching competency, we administered open-ended questionnaires to a sample of 128 Year 2 medical students in May 2011. RESULTS: The students placed high value on the ability to organize and summarize the lecture as the most significant competence of lecturers, due to the massive amounts of information that is disseminated in medical college. Further, they chose lecturers who communicated to students actively and used real clinical cases properly with regard to how medical knowledge applied. They also considered generating an interest in learning by linking knowledge and its application as an important priority of excellent lecturers. CONCLUSION: We conclude that there are differences in the characteristics and competencies of excellent lecturers, as perceived by medical students and others. To increase the quality of teaching, it might be necessary to offer the opportunity to observe excellent lecturers, develop faculty development programs, and create educational culture.

The Relationship between the Level of I-conscousness We-consciousness and Interpersonal Problems of Korean Medical Students.

PURPOSE: In Korea, students should have the consciousness of 'I' and 'we' to adapt well in society. Medical students in Korea must develop interpersonal and intrapersonal characteristics that are in accordance with Korean culture. This study intends to determine the relationship between the level of I-consciousness/we-consciousness and interpersonal problems in medical students. METHODS: The I-consciousness/we-consciousness Inventory and the Inventory of Interpersonal Problems were used for 212 first year medical students and 191 second year medical students at Yonsei University College of Medicine in 2008. RESULTS: The levels of I-consciousness/we-consciousness and interpersonal problems in medical students were higher than those of other general college students. There was a significant inverse correlation between the level of I-consciousness/we-consciousness and interpersonal problems for 118 of 130 factors. The higher the level of I-consciousness/we-consciousness in medical students is, the fewer interpersonal problems there are. CONCLUSION: Educational programs that take into account the consciousness of 'I' and 'we' are useful for the development of medical students' personalities.

Relationship between Learning Strategies and Academic Achievement in Medical College and Graduate Medical School Students.

PURPOSE: Cognitive researchers assume that learning strategies are related to three types of learning processes: 'surface learning,' 'strategy learning,' and 'deep learning.' A 'deep learning' approach is widely accepted to be associated with long-term success in medical school, contributing to the development of doctors who take desirable approaches to self-directed learning and studying in medical practice. Therefore, this study measured how medical students learn and determined whether the use of learning strategies differs between high and low academic performers. In addition, we compared medical college students with graduate medical school students with regard to the use of learning strategies. METHODS: To explore the learning strategies of students and their relation to academic achievement, we performed LIST (Learning Strategies in Higher Education Inventory) in a sample of 111 Year 1 medical students. RESULTS: Medical students with high academic performance scored higher in most learning strategies than low performers. Additionally, learning strategies were used more frequently by graduate medical school students than medical students, specifically with regard to organization, elaboration, critical thinking, and time management. CONCLUSION: We conclude that learning strategy instruments provide information that enables medical students to optimize their study. To foster deep learning and intrinsic motivation in students, it might also be necessary to adopt more changes in teaching and assessment in medical schools.

Estimation of optimal educational cost per medical student.

PURPOSE: This study aims to estimate the optimal educational cost per medical student. METHODS: A private medical college in Seoul was targeted by the study, and its 2006 learning environment and data from the 2003~2006 budget and settlement were carefully analyzed. Through interviews with 3 medical professors and 2 experts in the economics of education, the study attempted to establish the educational cost estimation model, which yields an empirically computed estimate of the optimal cost per student in medical college. RESULTS: The estimation model was based primarily upon the educational cost which consisted of direct educational costs (47.25%), support costs (36.44%), fixed asset purchases (11.18%) and costs for student affairs (5.14%). These results indicate that the optimal cost per student is approximately 20,367,000 won each semester; thus, training a doctor costs 162,936,000 won over 4 years. Consequently, we inferred that the tuition levels of a local medical college or professional medical graduate school cover one quarter or one-half of the per- student cost. CONCLUSION: The findings of this study do not necessarily imply an increase in medical college tuition; the estimation of the per-student cost for training to be a doctor is one matter, and the issue of who should bear this burden is another. For further study, we should consider the college type and its location for general application of the estimation method, in addition to living expenses and opportunity costs.