PURPOSE: The Korean Medical Licensing Examination (KMLE) has undergone a variety of innovative reforms implemented by the National Health Personnel Licensing Examination Board (NHPLEB) in order to make it a competency-based test. The purpose of this article is to describe the ways in which the KMLE has been reformed and the effect of those innovations on medical education in Korea. METHODS: Changes in the KMLE were traced from 1994 to 2014 by reviewing the adoption of new policies by the NHPLEB and the relevant literature. RESULTS: The most important reforms that turned the examination into a competency-based test were the following: First, the subjects tested on the exam were revised; second, R-type items were introduced; third, the proportion of items involving problem-solving skills was increased; and fourth, a clinical skills test was introduced in addition to the written test. The literature shows that the above reforms have resulted in more rigorous licensure standards and have improved the educational environment of medical schools in Korea. CONCLUSION: The reforms of the KMLE have led to improvements in how the competency of examinees is evaluated, as well as improvements in the educational system in medical schools in Korea.
Clinical Competence ; Education, Medical ; Health Personnel ; Humans ; Korea ; Licensure* ; Republic of Korea ; Schools, Medical

PURPOSE: It aims to identify the effect of five variables to score of the Korean Medical Licensing Examinations (KMLE) for three consecutive years from 2011 to 2013. METHODS: The number of examinees for each examination was 3,364 in 2011 3,177 in 2012, and 3,287 in 2013. Five characteristics of examinees were set as variables: gender, age, graduation status, written test result (pass or fail), and city of medical school. A regression model was established, with the score of a written test as a dependent variable and with examinees' traits as variables. RESULTS: The regression coefficients in all variables, except the city of medical school, were statistically significant. The variable's effect in three examinations appeared in the following order: result of written test, graduation status, age, gender, and city of medical school. CONCLUSION: Written test scores of the KMLE revealed that female students, younger examinees, and first-time examinees had higher performances.
Female ; Humans ; Licensure* ; Physical Examination ; Schools, Medical ; Test Taking Skills

PURPOSE: The purpose of this study is to test the reliability of the clinical performance examination (CPX) using Generalizability theory (G-theory). Through G-theory, the effects of not only students and tasks but also the school will be analyzed as primary sources of error, which can affect the interpretation of the reliability of the CPX. METHODS: One thousand three hundred nineteen students from 16 medical schools that participated in the Seoul-Gyeonggi CPX Consortium 2008 were enrolled. In our research design, we suppose that student is nested within school and crossed with task. Data analysis was conducted with urGenova. RESULTS: According to our analysis, the percentage of error variance was 6.2% for school, 14.9% for student nested within school, 14.4% for task, and 3% for interaction between school and task. An effect of school on students was observed, but the interaction between task and school was insignificant. When student is nested within school, the universe score decreased and the g-coefficient was less than the g-coefficient of the p x t (p: studentm, t: task) design. CONCLUSION: The results show that generalizability theory is useful in detecting various error components in the CPX. Using the generalizability theory to improve the technical quality of performance assessments provides us with greater information compared with traditional test theories.
Humans ; Research Design ; Schools, Medical ; Statistics as Topic

PURPOSE: In 2002, extended-matching type (R-type) items were introduced to the Korean Medical Licensing Examination. To evaluate the usability of R-type items, the results of the Korean Medical Licensing Examination in 2002 and 2003 were analyzed based on item types and knowledge levels. METHODS: Item parameters, such as difficulty and discrimination indexes, were calculated using the classical test theory. The item parameters were compared across three item types and three knowledge levels. RESULTS: The values of R-type item parameters were higher than those of A- or K-type items. There was no significant difference in item parameters according to knowledge level, including recall, interpretation, and problem solving. The reliability of R-type items exceeded 0.99. With the R-type, an increasing number in correct answers was associated with a decreasing difficulty index. CONCLUSION: The introduction of R-type items is favorable from the perspective of item parameters. However, an increase in the number of correct answers in pick 'n'-type questions results in the items being more difficult to solve.
Discrimination (Psychology) ; Education, Medical ; Licensure* ; Problem Solving

PURPOSE: In order to apply the item response theory to test results, the assumptions made about unidimensionality and item goodness-of-fitness should be tested before analysis. To know if the Korean Medical Licensing Examination results fulfill these assumptions, appropriate tests were done on these two features. METHODS: Three results(from three subjects) of the Korean Medical Licensing Examination, done in January 2004, were converted into 1, 0 data. The Holland and Rosenbaum Method(HRMH) and DETECT were used to test unidimensionality. The Winsteps was used to test goodness-of-fitness according to the Rasch model. RESULTS: Unidimensionality was rejected by HRMH but accepted by DETECT. With the Rasch model, 2 out of 550 items were inadequate. Each 137, 73 and 455 examinees out of 3,881 were inadequate in three subjects of 126, 400 and 24 items. CONCLUSION: The above results suggest that DETECT is desirable for testing unidimensionality of high-stakes tests with more than 100 items. According to the Rasch model, the Korean Medical Licensing Examination fulfills the goodness-of-fitness to be analyzed according to the item response theory.
Licensure* ; Netherlands

The passing rate of the Medical Licensing Examination has been variable, which probably originated from the difference in the difficulty of items and/or difference in the ability level of examinees. We tried to explain the origin of the difference using the test equating method based on the item response theory. The number of items and examinees were 500, 3,647 in 2003 and 550, 3,879 in 2004. Common item nonequivalent group design was used for 30 common items. Item and ability parameters were calculated by three parametric logistic models using ICL. Scale transformation and true score equating were executed using ST and PIE. The mean of difficulty index of the year 2003 was -0.957 (SD 2.628) and that of 2004 after equating was -1.456 (SD 3.399). The mean of discrimination index of year 2003 was 0.487 (SD 0.242) and that of 2004 was 0.363 (SD 0.193). The mean of ability parameter of year 2003 was 0.00617 (SD 0.96605) and that of year 2004 was 0.94636 (SD 1.32960). The difference of the equated true score at the same ability level was high at the range of score of 200-350. The reason for the difference in passing rates over two consecutive years was due to the fact that the Examination in 2004 was easier and the abilities of the examinees in 2004 were higher. In addition, the passing rates of examinees with score of 270-294 in 2003, and those with 322-343 in 2004, were affected by the examination year.
Discrimination (Psychology) ; Education, Medical ; Licensure* ; Logistic Models

Purpose: This study explored the possibility of using the Angoff method, in which panel experts determine the cut score of an exam, for the Korean Nursing Licensing Examination (KNLE). Two mock exams for the KNLE were analyzed. The Angoff standard setting procedure was conducted and the results were analyzed. We also aimed to examine the procedural validity of applying the Angoff method in this context. Methods: For both mock exams, we set a pass-fail cut score using the Angoff method. The standard setting panel consisted of 16 nursing professors. After the Angoff procedure, the procedural validity of establishing the standard was evaluated by investigating the responses of the standard setters. Results: The descriptions of the minimally competent person for the KNLE were presented at the levels of general and subject performance. The cut scores of first and second mock exams were 74.4 and 76.8, respectively. These were higher than the traditional cut score (60% of the total score of the KNLE). The panel survey showed very positive responses, with scores higher than 4 out of 5 points on a Likert scale. Conclusion The scores calculated for both mock tests were similar, and were much higher than the existing cut scores. In the second simulation, the standard deviation of the Angoff rating was lower than in the first simulation. According to the survey results, procedural validity was acceptable, as shown by a high level of confidence. The results show that determining cut scores by an expert panel is an applicable method.

PURPOSE: This study was conducted to examine the effects of a telephone-based self-management support program led by nurses on self-care behavior, biological index for cardiac function, and depression. METHODS: This study is a quasi-experiment in nonequivalent control group design. Thirty-eight heart failure patients underwent medical treatment at the hospital (18 heart failure patients in the experimental group and 20 heart failure patients in the control group). The experimental group (n = 18) received the telephone-based self-management support program, which included a 30-minute face-to-face education session and four telephone consultation and education sessions. The face-to-face education session was conducted at the first visit to the outpatient clinic. Thereafter, weekly telephone consultations and education sessions were performed for 4 weeks. Data were analyzed using descriptive statistics, Chi-square test, Fisher's exact test, independent t test, paired t test, and repeated measures analysis of variance using the SPSS/WIN 21.0. RESULTS: The participants in the experimental group showed significantly increased self-care behavior scores (t = 6.65, p < .001), decreased N-terminal pro-brain natriuretic peptide level (U= −2.28, p = .022), improved left ventricular ejection fraction values (t = 2.24, p = .032), and decreased depression scores (t = −3.49, p = .001) compared with the control group. CONCLUSION: The findings indicate that the telephone-based self-management program is an effective intervention to improve self-management in heart failure patients.
Ambulatory Care Facilities ; Depression* ; Education ; Heart Failure* ; Heart Function Tests ; Heart* ; Humans ; Referral and Consultation ; Self Care* ; Stroke Volume ; Telephone

The aim of this study was to investigate respondents' satisfaction with smart device-based testing (SBT), as well as its convenience and advantages, in order to improve its implementation. The survey was conducted among 108 junior medical students at Kyungpook National University School of Medicine, Korea, who took a practice licensing examination using SBT in September 2015. The survey contained 28 items scored using a 5-point Likert scale. The items were divided into the following three categories: satisfaction with SBT administration, convenience of SBT features, and advantages of SBT compared to paper-and-pencil testing or computer-based testing. The reliability of the survey was 0.95. Of the three categories, the convenience of the SBT features received the highest mean (M) score (M= 3.75, standard deviation [SD]= 0.69), while the category of satisfaction with SBT received the lowest (M= 3.13, SD= 1.07). No statistically significant differences across these categories with respect to sex, age, or experience were observed. These results indicate that SBT was practical and effective to take and to administer.
Gyeongsangbuk-do ; Humans ; Korea* ; Licensure ; Personal Satisfaction ; Republic of Korea ; Students, Medical* ; Tablets

PURPOSE: Smart device-based testing (SBT) is being introduced into the Republic of Korea’s high-stakes examination system, starting with the Korean Emergency Medicine Technician Licensing Examination (KEMTLE) in December 2017. In order to minimize the effects of variation in examinees’ environment on test scores, this study aimed to identify any associations of variables related to examinees’ individual characteristics and their perceived acceptability of SBT with their SBT practice test scores. METHODS: Of the 569 candidate students who took the KEMTLE on September 12, 2015, 560 responded to a survey questionnaire on the acceptability of SBT after the examination. The questionnaire addressed 8 individual characteristics and contained 2 satisfaction, 9 convenience, and 9 preference items. A comparative analysis according to individual variables was performed. Furthermore, a generalized linear model (GLM) analysis was conducted to identify the effects of individual characteristics and perceived acceptability of SBT on test scores. RESULTS: Among those who preferred SBT over paper-and-pencil testing, test scores were higher for male participants (mean± standard deviation [SD], 4.36± 0.72) than for female participants (mean± SD, 4.21± 0.73). According to the GLM, no variables evaluated— including gender and experience with computer-based testing, SBT, or using a tablet PC—showed a statistically significant relationship with the total score, scores on multimedia items, or scores on text items. CONCLUSION: Individual characteristics and perceived acceptability of SBT did not affect the SBT practice test scores of emergency medicine technician students in Korea. It should be possible to adopt SBT for the KEMTLE without interference from the variables examined in this study.
Emergencies ; Emergency Medical Technicians ; Emergency Medicine ; Female ; Humans ; Korea ; Licensure ; Linear Models ; Male ; Multimedia ; Personal Satisfaction ; Republic of Korea