Team dynamics and clinical performance of medical students in web-based and high-fidelity simulations / 한국의학교육

PURPOSE: The importance of team dynamics with regard to clinical performance is being emphasized to improve patient safety and the quality of health care. The aim of this study was to examine the correlation and differences in team dynamics and team clinical performance in a web-based simulation (WS) and high-fidelity simulation (HS) in the medical students. METHODS: The simulations were held for 15 teams of fourth year medical students (n=52). They were given two clinical cases, dyspnea (case 1) and chest pain (case 2) by WS and then HS. The scores on the team dynamics and the team's clinical performance were analyzed by paired t-test and multiple regression using SPSS version 21.0 (IBM Corp.). RESULTS: The teamwork scores on case 2 (22.67+/-6.58) were higher than for case 1 in the HS (20.47+/-7.22). Team clinical performance scores were the same the WS and HS. Team clinical performances were significantly associated with team dynamics in both cases by HS. Teamwork scores of team dynamics were each explanation on case 1 (74.9%), case 2 (63.4%) in the HS. CONCLUSION: The team dynamics and clinical performance can improve if undergraduate medical students have more opportunities. They should be trained in these endeavors to become future doctors for which scenario-based simulations could be valuable.

Correlation between clinical clerkship achievement and objective structured clinical examination (OSCE) scores of graduating dental students on conservative dentistry

OBJECTIVES: This study aimed to investigate the effect of clinical clerkship-associated achievements, such as performance of procedures at the student clinic, observation, and attitude towards a clerkship, on the objective structured clinical examination (OSCE) scores of dental students graduating in restorative dentistry. MATERIALS AND METHODS: The OSCEs consisted of two stations designed to assess students' clinical skills regarding cavity preparation for a class II gold inlay and a class IV composite restoration. The clerkship achievements, consisting of the number of student clinical procedures performed, observation-related OSCE, and scores of their attitudes towards a conservative dentistry clerkship, were assessed. Correlation and multiple regression analyses were conducted. RESULTS: The correlation coefficient between the OSCE scores for cavity preparation for a class II gold restoration and clerkship attitude scores was 0.241 (p < 0.05). Regarding a class IV composite restoration, OSCE scores showed statistically significant correlations with the observation (r = 0.344, p < 0.01) and attitude (r = 0.303, p < 0.01) scores. In a multiple regression analysis, attitudes towards a clerkship (p = 0.033) was associated with the cavity preparation for a class II gold inlay OSCE scores, while the number of procedure observations (p = 0.002) was associated with the class IV composite restoration OSCE scores. CONCLUSIONS: The number of clinical procedures performed by students, which is an important requirement for graduation, showed no correlation with either of the OSCEs scores.

Simvastatin inhibits osteoclast differentiation by scavenging reactive oxygen species

Osteoclasts, together with osteoblasts, control the amount of bone tissue and regulate bone remodeling. Osteoclast differentiation is an important factor related to the pathogenesis of bone-loss related diseases. Reactive oxygen species (ROS) acts as a signal mediator in osteoclast differentiation. Simvastatin, which inhibits 3-hydroxy-3-methylglutaryl coenzyme A, is a hypolipidemic drug which is known to affect bone metabolism and suppresses osteoclastogenesis induced by receptor activator of nuclear factor-kappaB ligand (RANKL). In this study, we analyzed whether simvastatin can inhibit RANKL-induced osteoclastogenesis through suppression of the subsequently formed ROS and investigated whether simvastatin can inhibit H2O2-induced signaling pathways in osteoclast differentiation. We found that simvastatin decreased expression of tartrate-resistant acid phosphatase (TRAP), a genetic marker of osteoclast differentiation, and inhibited intracellular ROS generation in RAW 264.7 cell lines. ROS generation activated NF-kappaB, protein kinases B (AKT), mitogen-activated protein kinases signaling pathways such as c-JUN N-terminal kinases, p38 MAP kinases as well as extracellular signal-regulated kinase. Simvastatin was found to suppress these H2O2-induced signaling pathways in osteoclastogenesis. Together, these results indicate that simvastatin acts as an osteoclastogenesis inhibitor through suppression of ROS-mediated signaling pathways. This indicates that simvastatin has potential usefulness for osteoporosis and pathological bone resorption.

Two Year Experiences of the International Elective Clerkship for Medical Students / 영남의대학술지

BACKGROUND: The aims of medical education have recently been changing in Korea, which has been accompanied by efforts to modify the rotating clerkship courses, improve the quality of clinical education, and make global doctors. We report the experiences of medical students going through an international elective clerkship for during past two years. MATERIALS AND METHODS: Third year medical students could apply to the international elective clerkship course during a 4 week period after their third-year rotating clerkship at a university hospital. This was done twice-in 2008 and in 2009. Applicant students were allowed to select hospitals anywhere in the world. We analyzed their choices including data on nation, state or city, hospital or institute, contacted hospitals by medical college, differences of two years, etc. RESULTS: Twelve students (10.9%) of a total of 75 third-year students applied to 3 nations and 4 hospitals in 2008. Nine students applied to the Tampa General Hospital at the University of South Florida (USF) in the USA, which was arranged by their medical college. In 2009, a total of five (4.2%) of 77 students applied to 2 nations and 3 hospitals, including three at the University of South Florida, one in another city in the USA, and one in another nation because of the increased financial burden due to a higher exchange rate. CONCLUSION: Medical students started their first international elective clerkship courses during the past two years. Experiences were interesting and meaningful to the students and the medical college. Greater effort and support to developing a new paradigm and to enlarge the scope of the program for making global doctors are required in the future.

Evaluation of Curriculums of Medical Schools for Fostering Various Basic Qualities of Medical Professionalism / 한국의학교육

PURPOSE: Today, the social requirement of medicine emphasizes the importance of medical professionalism. This forces medical educators to introduce new contents and methods into the curriculum. This study aims to offer ideas for developing the curriculum through clarifying priorities on the basic qualities of medical professionalism and evaluating the current curriculums in medical schools in South Korea. METHODS: In April 2005, 46 respondents majoring in basic medical sciences, clinical medicine, and medical humanities/social sciences completed a structured questionnaire. The questionnaire consisted of 3 categories related to: 1) the basic qualities of medical professionalism/general education courses, 2) the process of developing the qualities of humanities and social sciences in medical education, and 3) the appropriate allocation of credits for each subject to premedical and medical courses. The analysis consisted of frequency, chi-square, and multiple responses using Korean Ed, SPSS 14.0 for Windows. RESULTS: The most important basic quality is basic medical knowledge. The credits for the general education are sufficient but it's contribution is lacking (44.44%). The most lacking element in the general education courses is socio-cultural comprehension (45.65%). The knowledge of humanities and social sciences is very important in developing the basic qualities (56.52%). The important learning experiences related to these is the introspection into human beings (32.16%). Credits for medical humanities classes in premedical and medical course are noticeably insufficient (45.65, 54.35%, respectively). The appropriate program of informal curriculum for fostering the qualities is meeting with various medical specialists (44.44%, 47.83%, respectively). There is almost no difference among the major groups under (p<.05.) CONCLUSION: To assist medical students to be equipped with the basic qualities of medical professionalism, the realm of medical humanities should be made mandatory; and the general education courses need to be reformed, especially in the premedical curriculum. In particular, continuous cooperation between faculties in medicine, liberal arts, and/or social sciences need to exist with the conglomeration of these into fewer medical humanities majors in Korea.

Effects of Rater's Presence in OSCE Station on Examinee's Scores and Performance / 한국의학교육

PURPOSE: It is uncertain whether the rater's presence during administration of the objective structured clinical examination (OSCE) has any impact on examinee performance. To clarify this issue, the effects of a rater's presence during testing on OSCE score and examinee responses were analyzed. METHODS: The OSCE comprised 24 stations of 12 duplicated cases. Twenty-eight of 83 fourth-year medical students were placed in four rater-absent stations (pediatrics, 2 stations; internal medicine, 2 stations). The scores of the rater-absent group were assessed after review of recorded videotapes. We obtained student responses on the rater's presence by means of a questionnaire. Statistical analysis (t-test) was performed using SPSS 14.0. RESULTS: The scores of the rater-absent group compared with the rater-present group were 78.57+/-16.27 vs. 70.55+/-19.57 (p=0.066) for pediatrics, 66.07+/-14.74 vs. 64.36+/-14.88 (p=0.621) for internal medicine, and 67.75+/-5.43 vs. 69.13+/-4.85 (p=0.099) for total score, respectively. Subjects in the rater-absent group felt that they were in a real-life clinical situation (p=0.013) and concentrated better (p=0.006), and more students requested to take the OSCE without a rater in the station (p=0.000) than those in rater-present group. CONCLUSION: Although there was no significant difference in OSCE scores between the rater-absent and rater-present examinee groups, subjects at rater-absent stations felt more of a real clinical situation and could concentrate more effectively than those at rater-present stations. To this end, videotaped OSCE assessments should be considered to increase the validity of the examination.

Introduction of Medical Simulation and the Experience of Computerized Simulation Program Used by MicroSim(R) / 영남의대학술지

BACKGROUND: Computer- and web-based simulation methods help students develop problem solving and decision making skills. In addition, they provide reality based learning to the student clinical experience with immediate medical feedback as well as repetitive training, on-site reviews and case closure. MATERIALS AND METHODS: Seventy-five third-year medical students participated in a two-week simulation program. The students selected four modules from eight modules as follows: airway and breathing 1, cardiac arrest 1, cardiac arrhythmia 1, and chest pain 1, and then selected the first case within each of the modules. After 2 weeks, a pass score was obtained and the data analyzed. The average pass score of over 70% was considered a passing grade for each module. If the student did not pass each module, there was no score (i.e., pass score was zero). In addition, when at least one of the four modules was zero, the student was not included in this study. RESULTS: Seventy-five students participated in the simulation program. Nineteen students were excluded based on their performance. The final number of students studied was 56 students (74.7%). The average scores for each module 1 to 4 were 86.7%, 85.3%, 84.0%, and 84.0%, and the average obtained pass score was 88.6 for the four modules in all 56 students. CONCLUSION: Medical simulation enabled students to experience realistic patient situations as part of medical learning. However, it has not been incorporated into traditional educational methodology. Here we describe the introduction and the development of various simulation modules and technologies for medical education.

The Operating Status of Medical Education Management Units in Korea / 한국의학교육

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.