PURPOSE: Standardized patients participate in clinical performance examinations not only to simulate case scenarios but also to evaluate the performance of students using a checklist. The accuracy in checking off checklist items is one of the most important factors determining the reliability of this examination. The purposes of this study were to determine the SP' s overall accuracy in recording checklist items, and whether their accuracy was affected by certain characteristics of checklist items. METHODS: Three professors, who have been fully involved in scenario development and SP training, reviewed videotapes of the examination and evaluated the performance of the students using the same checklist. SP' s checklists were marked on this 'correct checklist'. The checklists and checklist guidelines of the items marked under the score of 50 out of 100 were analyzed. RESULTS: Results showed that the accuracy of the SP' s in recording checklist items was 86.9% and was affected by certain characteristics, such as complexity or ambiguity of checklists and checklist guidelines. CONCLUSION: In this study, the SP' s accuracy in recording checklist items was good to very good, and the result suggested that the accuracy could be improved by the elaboration of checklists and checklist guidelines.
Checklist* ; Educational Measurement ; Humans ; Observer Variation ; Videotape Recording

PURPOSE: During the high-stake examinations such as OSCE (Objective structured clinical examination) or CPX (clinical performance exam), test security is generally accepted as a major concern for test validity. This study was conducted to investigate the effect on examinee' s scores of repeated, serial administrations of essentially the same standardized patient (SP) -based performance exam. METHODS: A performance-based examination using eight SP cases was administered to 123 senior medical students at Hanyang University School of Medicine. Students were randomly assigned to one of 16 groups of 8 students each. Three groups were tested serially each day, requiring 5 days for the complete administration of the examination. We compared the mean scores of the five groups of the examinees tested on different days with ANOVA and linear trends with multiple regression analyses. RESULTS: For both checklist scores and written scores during the interstation work, the mean scores of the first day groups were significantly lower compared to subsequent groups. And, there were slight linear trends in the scores over the five days. Scores related to case-specific history taking, information sharing, and clinical courtesy were significantly affected by the sharing of information between students. Scores related to patient satisfaction, physical exam, and physician-patient interaction were not influenced by the same pattern of behaviour. CONCLUSION: Test security may be violated during SP-based performance exams even though the checklists are not accessible to the examinees. It would be desirable for the test-givers to prepare alternative forms of cases for maintaining the validity of SP-based performance exams.
Checklist ; Clinical Competence ; Humans ; Information Dissemination ; Patient Satisfaction ; Students, Medical

PURPOSE: To compare the evaluation results of faculties to those of Standardized Patients (SP) participating in a Clinical Performance Examination (CPX) administered at Ewha Womans University College of Medicine. METHODS: The CPX was taken by 77 fourth year medical students. Cases and checklist were developed by the medical school consortium in capital area. Six cases were used and 24 SPs participated and evaluated the students' performances. The whole session was recorded on videotapes so that 6 medical school faculties could analyze and evaluate the students' performances as well. The results were compared and analyzed by SPSS package. RESULTS: The agreement between the faculties and the SPs was relatively good (r=0.79), but not good enough. In every case, SPs gave higher marks than did the faculties. Clear disease entity cases like "hepatitis" and "anemia" showed better agreement than obscure clinical contexts such as "bad news delivery". Better agreement was seen in the items of physical exam category (r=0.91), but the agreement was very poor in the items of doctor-patient (Dr-Pt) relationship category (r=0.54). The construction of checklist and the character of each evaluation item should influence the differences. CONCLUSION: More detailed guidelines and clear/specific evaluating items are necessary to improve the agreement rate. In certain categories like physical exam and brief history taking, the SP' s evaluation can replace the faculties', but for complex contexts like Dr-Pt relationship.
Checklist ; Female ; Humans ; Schools, Medical ; Students, Medical ; Videotape Recording

PURPOSE: The purpose of the study is to analyse the appropriateness of using standardized patients' (SPs) assessment scores of medical students in clinical performance examination (CPX). METHODS: 110 fourth year medical students in year four were divided into two large groups (group A and group B). Each group of students performed four different cases and overall, eight cases were tested. The examination were done by professors and the SPs using the same examination paper. Test scores were analysed per station and per each test domain. The differences between the two examiners were studied using paired t-test. RESULTS: There were significant differences in the scores given out by the professors' and the SP' s in four out of the eight stations. According to the examination results of each domain, four cases showed significant differences in the history taking category, three cases in the physical examination, one case in the information sharing, four cases in clinical courtesy, and two cases in physician-patient relationship category. Cronbach' s alpha scores of all stations were over 0.6, reflecting that the test items were appropriate for the examination. CONCLUSION: From the result of this study and according to many preceding studies, using SPs' evaluation scores in CPX is appropriate. Some limitation of this study and ideas for improvement in using SPs in CPX are suggested.
Humans ; Information Dissemination ; Physical Examination ; Students, Medical

PURPOSE: This study aims to abstract the differences of scores between the clinical instructors and standardized patients (SPs) in a clinical performance examination (CPX) using SPs and to correlate the concordance between the evaluation scores and the school records. METHODS: The CPX was administered in 2003 to a total of thirty-six fifth year medical students at Gachon Medical School. The examination consisted of four cases, and four stations were duplicated, each requiring a total of 7.5 minutes per station. Evaluation of the student' s performances was conducted by both clinical instructors and SPs using a formatted checklist. Results were analysed by t-test, agreement rates, and Pearson correlation. RESULT: The mean scores given out by the clinical instructors and the SPs for the newly developed case were significantly different, while those scores for pre-existing cases were not in the old cases. The correlation coefficients between these two evaluation groups were relatively high. And agreements between the two evaluation groups were 0.37~0.72. The mean scores among clinical instructors were not significantly different, but the correlation coefficients and agreement rates were relatively high. The correlation between the evaluation scores and school records did not correlate significantly. CONCLUSION: It is concluded that the CPX is a useful tool to measure the students' essential competences in areas of knowledge, skills and attitude during the subinternship stage. In conducting a successful CPX, it is crucial to reconsider the recycling of cases and the selection and training of SPs aside from the development of an objective checklist.
Checklist ; Clinical Competence ; Humans ; Recycling ; Schools, Medical* ; Students, Medical

PURPOSE: We taught medical students how to break bad news to medical students using the SPIKES protocol and investigated its efficacy. METHODS: After developing the program, we taught the 16 medical students doing their family medicine rotation. We surveyed their self-reported performance prior to the teaching and their satisfaction and change in confidence level after the teaching. Using standardized patients(SP), we also analyzed the difference in clinical performance between educated and non-educated groups. RESULTS: Students were satisfied with the education program and 12 students showed increased confidence levels. However, there was no difference in clinical performance between eduated and non-educated group, even after categorization of the exam. CONCLUSION: Self-confidence for delivering bad news increased but there was no evidence of improvement in clinical performance. Communication skills training should be repeatedly performed in each medical educational curriculum.
Curriculum ; Education ; Humans ; Students, Medical

PURPOSE: The purpose of this study is to investigate the trends and traits of moral sensitivity and reasoning over six years of medical school. METHODS: The participants in this study consisted of 217 first to sixth-year medical students of Sungkyunkwan University School of Medicine in Korea. Essay type questionnaire was used for evaluating moral sensitivity and the Korean-Defining Issues Test (KDIT) was used for evaluating moral reasoning. RESULTS: It was found that the medical students' sensitivity of 'public welfare', 'prospective result' and 'role-taking as a doctor' was significantly higher than that of the pre-medical students'. Moral sensitivity increased in the 3rd and the 4th years but decreased in the 5th and the 6th years. Moral reasoning decreased in the 3rd and the 4th years but increased in the 5th and the 6th years. No correlation was observed between moral sensitivity and reasoning(r=0.033). Developmental trends of moral sensitivity and reasoning showed a significant difference in terms of year of medical school. CONCLUSION: The results suggest that medical school curriculum tends to impct students' moral sensitivity. This school has implemented the problem-based learning curriculum into the 3rd and the 4th years. It is necessary to consider the developmental state of the student's morality when developing an effective medical ethics program.
Curriculum ; Ethics, Medical ; Humans ; Korea ; Morals ; Problem-Based Learning ; Schools, Medical ; Students, Medical* ; Surveys and Questionnaires

PURPOSE: The purpose of this study is to investigate the learning styles of students at Kyungpook National University(KNU) School of Medicine and to assess its implications on teaching-learning methods in medical school. METHODS: 571 students in all years of medical school were invited to complete a questionnaire via online. For this study, Felder's Index of Learning Styles(ILS) was used, which included 49 items. Felder's ILS measures the learner's relative preference for each of the five dichotomous learning style dimensions. RESULTS: 242(42.3%) students completed the questionnaire. More than 80% preferred sensitive information and more than 60% preferentially took in visual information. Both males and females preferred sensing and visual learning materials. On average, The students at KNU school of Medicine were reflective, sensing, visual, global and inductive. CONCLUSION: From these results, we suggested some effective methods of teaching-learning based on the students' preferences and some perspectives for future works.
Education, Medical ; Female ; Gyeongsangbuk-do ; Humans ; Learning* ; Male ; Schools, Medical* ; Surveys and Questionnaires

PURPOSE: Senior medical students agreed to undergo gastrofibroscopy testing in the same manner as patients would in order to assess if the experience affects their understanding of patients' discomfort and their recommendation of this test. METHODS: 27 senior medical students rotating through family medicine underwent gastrofiberscopy. The level of discomfort experienced by these students was evaluated by using the Visual Analogue Scale(VAS). Each student's recommendation of gastrofibroscopy or upper gastrointestinal series to asymptomatic and symptomatic adults with upper GI complaint was recorded. And we assessed the need of patient experience for recommendation of gastrofibroscopy. RESULTS: Before having experienced a gastrofibroscopy, 21 students recommended gastrofibroscopy (21 cases, 77.8%) and 6 recommended upper gastrointestinal series(6 cases, 22.2%) as screening tests in asymptomatic adults. After having had a gastrofibroscopy, gastrofibroscopy was recommended in 16 cases(59.3%) and the upper gastrointestinal series in 11(40.7%), again in asymptomatic adults. However in symptomatic adults, there was no change. The degree of discomfort after having had a gastroscopy was less than they thought(5 cases, 18.5%), the same (5 cases, 18.5%), and more than they thought(17 cases, 63.0%), 25(92.5%) students thought experiencing gastrofibroscopy would help them explain the procedure to patients in the future. 26(96.3%) students expressed that doctors who recommend gastrofibroscopies should experience having the test so that they can better empatize and understand patients' discomfort. CONCLUSION: Senior medical students' experience being a patient is a significant learning opportunity for understanding the patient discomfort. This experience will help doctors understand patient's discomfort.
Adult ; Gastroscopy ; Humans ; Learning ; Mass Screening ; Students, Medical

PURPOSE: The purpose of this study was to estimate the operating status of existing medical education management units in medical colleges and to define the roles of these units to provide basic information to medical schools contemplating to establish similar management units. METHODS: A structured questionnaire survey was conducted via mail. The survey 41 medical colleges across the nation and was done during September 2003 and March 2005. The assessment instrument included six items assessing the organizational structure, composition, major activities, self-satisfaction with performance, administration and financial aspects and the need for further development in the medical education unit for medical colleges with a medical education management unit. There were only two items assessing demand for establishment of a medical education management unit, prerequisite conditions for establishment, the expected role of such a system for medical colleges without a medical education management unit. RESULTS: Of 41 medical colleges, 18 had a medical education management unit as of September 2003 and 32 as of March 2005. The major activities of these 18 management units included curriculum development(26.7%), faculty development(26.7%), support for PBL(16.0%) and OSCE(12.0%). Recently, these units have become involved in enhancing clinical clerkship as well as improving teaching skills. To have a medical education-related unit run smoothly, at least two tenured faculty members majoring in education and medical education were needed. And a compensation systems was required for those professors working in the unit as a second post but without pay. CONCLUSION: This study underscored the importance of professional faculty members, and administrative and financial supports in having a medical education management unit meet its objectives. The role of the dean of medical college seems crucial in deciding how the unit is operated.
Clinical Clerkship ; Compensation and Redress ; Curriculum ; Education ; Education, Medical* ; Financial Support ; Korea* ; Postal Service ; Schools, Medical ; Surveys and Questionnaires