Experience with Clinical Performance Examination using Standardized Patients at Gachon Medical School / 한국의학교육

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.

Multicampus Medical Education in Korea: Issues and Strategies for Emphasizing the Advantages / 한국의학교육

PURPOSE: This study was designed to analyze the current status of multicampus medical education in Korea, to identify its educational significance, and to develop strategies for overcoming such disadvantages. METHODS: The logistic data were collected from 41 medical schools, and the educational impacts based on the location of campuses and clinical teaching hospitals, types of education, major functions, and collaboration system between campuses were analyzed. RESULTS: 35 from 41 medical schools ran various forms of multicampus education, and only 8 claimed a system that bridged the school campus and teaching hospital (s). However, none were equipped with any form of meaningful liaison accommodating a distant learning system between learning centers. Regardless, the advantages of multicampus school system aimed to provide a wide range of learning experiences, serious disadvantages remained without the system developing an effective method for overcoming difficulties of communication or establishing an achievement to reach a common educational consensus. CONCLUSION: Various advantages of multicampus system in terms of producing pleuripotential physicians have been rationalized, but any measures for their effective collaboration remains limited. This paper stresses the development of a responsible unit for better support between school campus and clinical teaching centers in multicampus curriculum planning. It is also crucial to design an educational communication channel between them.

Program Development of Student Internship (Subinternship) in Gachon Medical School / 한국의학교육

PURPOSE: This study aims to explore an one-year experience of intensive core clinical clerkship (student internship, subinternship) in Gachon Medical School for junior clinical students, and the immediate outcome of the program was discussed along the with advantages and student load. METHODS: 36 junior medical students (M5) were exposed to 36 weeks of core clinical clerkship including internal medicine (12wks), pediatrics (6wks), obstetrics-gynecology (6wks), general surgery (4wks), psychiatry (4wks), and emergency medicine (4wks). The clinical service team was made of faculty member (1), senior resident (1), intern (1) and M5 students (1-2), and the students who were involved a wide range of baseline responsibilities corresponding to those of regular rotating interns. They were encouraged to participate the various procedures and decision making process, but their participation was restricted by keeping 3 levels of performance policy according to degree of supervision. Questionnaire analysis was carried out immediate after the student internship. RESULTS: Students were proud of themselves being as the subinterns and showed a strong motivation, while they had a difficulty to tolerate a strong psychologic pressure by taking their roles of subinternship. Major responsibilities of clerkship were focused on the clinical information collection (history taking and physical examination), students-directed group conference, faculty-led small group discussion, technical skill learning and ward round in order. Students appreciated well to this internship in terms of acquisition of clinical skills and identification of their role, but shortage of space, frequent on-call, lack of self-directed learning opportunity, unclarified requests from the hospital authority were pointed out. CONCLUSION: It is assumed that student internship is a strong tool to promote the quality of clinical learning process, but requires details of teaching instructions (manuals) aside from solving a series of legal on malpractice, for which critical defining of clinical participation is essential to upgrade the Korean version of clerkship.

Development of an Evaluation Baseline Module for Clinical Clerkship: Gachon Medical School Experience / 한국의학교육

PURPOSE: The aims of this paper are to develop a student evaluation format as a part of core clinical clerkship (student internship) program at Gachon Medical School, and to identify its impeding factors in implementation. METHODS: Both rating scale of Likert type and check list for student's clerkship assessment were designed; the rating scale format was developed into two parts, namely attendance and the clinical competence demonstrated during the clerkship in which 3 domains of knowledge, skills and attitude were included in balance; the professional competence was made of 9 items, each being designed to accommodate 3 degrees by learner's performance. The clinical instructors in charge were requested to sit a short feedback session on the evaluation results with students who were signed at the end. Nursing staff was also asked to participate in evaluation of the student attitude in a limited area. RESULTS: Despite the full acceptance of the evaluation approach theoretically, its practical implementation was not successful because of difficulties related to adjustment of their department-based scoring system to the comprehensive assessment, or unfamiliarity with face-to-face feedback system. CONCLUSION: The authors assume that this Likert type of the rating scale is a simple, more comprehensive and strong tool to meet the learning objectives, and easy to enhance the feedback effect. It is, however, advised that the formative reporting system is crucial to transform the traditional evaluation approach into the pass/fail format so that unnecessary conversion risk is eliminated.

'Global Citizenship' Course in Premedical Year Development and Outcome of Manner Program for Future Physicians / 한국의학교육

PURPOSE: This study aims to introduce a one semester 'Global Citizenship' program, being offered as a part of the premedical course at Gachon Medical School. The program was designed to meet the community needs in terms of etiquette and manner education for the future physicians and also to review the outcome of short-term experience. METHODS: The program was offered to M1(premedical students year-1) students from the first semester after entrance to the school with following objectives: to understand the anthropological aspect of culture, to motivate students in relation to medical scientific foundation, and to develop the appropriate human relations, including international etiquette and manners, prior to the subinternship in M5(medical student year-3). RESULTS: The program consisted of 12 sessions of lectures and/or practice-based learning such as etiquette for dormitory life, Korean traditional culture, gender role in the 21st century, dining etiquette in various cultural programs, netiquette(for computer usage), Korean housing and its architectural beauty, etiquette for alcoholic beverage drinking, dressing, and the respect and understanding of other cultures, services and manners. They were all instructed with presentations combined with site-visits or hands-on experience followed by a reflection paper and group discussion. Although the program was costly and time-consuming compared to the traditional theory-based natural science and humanity subjects, students expressed their strong motivation and concerns on their future responsibilities. CONCLUSION: We conclude that "Global Citizenship" course is a useful program to provide a meaningful motivation to the newly enrolled students, Further, it encourages students to understand human relations as a global citizen equipped with the appropriate etiquette and manners.

The Operational Design of Clinical Skills Training Program in Gachon Medical School / 한국의학교육

PURPOSE: The purpose of this study is to introduce the operational design of clinical skills training program and to evaluate the outcome of one-year experience in Gachon Medical School. METHODS: The School set up a clinical skills training center(laboratories) helping preclinical year-students being able to improve their clinical competences by using simulators and models prior to start their clerkship so that they can apply accurate and stable clinical technical skills to the patients. The program was divided into two parts; one for the communication and interviewing skills(M3) and the other for development of basic clinical skills(M4). For the latter, a total of 32 skill units with model items were selected from the minimum essential clinical skills requirements. The training course was conducted 3 weeks for 37 students of the fourth year medical school(M4) students in the second semester of 2001. Pass/Fail system with 2 credits was applied as a student evaluation. Both advantages and disadvantages of the program were analysed by questionnaires. RESULTS: Every students met the school requirement and passed the requirements mostly by the second trial within the two weeks duration following self-directed hard practice for every items. Of 37 students, 80% became confident on their final performance, and 72% agreed themselves being much enthusiastic compared to other courses. The visiting frequency to the center was over 2~3 times/day during the course, and their average staying hours/week were 20~30 hours. Students(78%) were satisfactory to the appropriativeness of faculty's instructional skills and their evaluation results. CONCLUSION: We conclude that the clinical skills training program is a useful tool not only to improve the essential technical skills prior to take their responsibilities of subinternship but also to motivate students' learning during the preclinical studies.