Instructor factors associated with medical students’ lecture evaluation: a longitudinal analysis / 한국의학교육

Purpose@#This study identified factors that affect lecture evaluation by analyzing sophomores from Dankook University, examining each cluster’s characteristics, and comparing differences among trajectories. @*Methods@#This study identified factors that affect lecture evaluation by analyzing sophomores from Dankook University, examining each cluster’s characteristics, and comparing differences among trajectories. @*Results@#The lecture evaluation score decreased as the teaching hours per instructor in a year increased by an hour, and the number of instructors per lecture increased by one individual. During trajectory analysis, the first trajectory had lower lecture evaluation scores overall but relatively high appropriateness of the textbook and punctuality of class, whereas the second trajectory had higher lecture evaluation scores overall for all four items. @*Conclusion@#The two trajectories showed differences in teaching methods (understanding of lecture content and usefulness of the lecture) rather than in external factors (appropriateness of the textbook and punctuality of class). Therefore, to improve lecture satisfaction, enhancing instructors’ instructional competencies through lectures and adjusting the teaching hours by assigning an adequate number of instructors per lecture are recommended.

Analysis and suggestions on medical educators’ roles / 한국의학교육

Purpose@#This study aimed to investigate the differences in the perception between professors and students regarding medical educators’ roles and discuss their desirable roles. @*Methods@#A survey was administered to 116 professors and 379 students of the medical colleges from Dankook University and Hallym University. The subjects were given a self-created questionnaire designed to measure their perception of medical educators’ roles. @*Results@#First, “student performance management” for professors and “teaching skill development” for students were recognized as the most essential medical educators’ role. Second, females students perceived the roles to be more important than males in eight of 10 roles. @*Conclusion@#First, “student performance management” for professors and “teaching skill development” for students were recognized as the most essential medical educators’ role. Second, females students perceived the roles to be more important than males in eight of 10 roles.

The relationship between classical item characteristics and item response time on computer-based testing / 한국의학교육

PURPOSE: This study investigated the relationship between the item response time (iRT) and classic item analysis indicators obtained from computer-based test (CBT) results and deduce students' problem-solving behavior using the relationship. METHODS: We retrospectively analyzed the results of the Comprehensive Basic Medical Sciences Examination conducted for 5 years by a CBT system in Dankook University College of Medicine. iRT is defined as the time spent to answer the question. The discrimination index and the difficulty level were used to analyze the items using classical test theory (CTT). The relationship of iRT and the CTT were investigated using a correlation analysis. An analysis of variance was performed to identify the difference between iRT and difficulty level. A regression analysis was conducted to examine the effect of the difficulty index and discrimination index on iRT. RESULTS: iRT increases with increasing difficulty index, and iRT tends to decrease with increasing discrimination index. The students' effort is increased when they solve difficult items but reduced when they are confronted with items with a high discrimination. The students' test effort represented by iRT was properly maintained when the items have a 'desirable' difficulty and a 'good' discrimination. CONCLUSION: The results of our study show that an adequate degree of item difficulty and discrimination is required to increase students' motivation. It might be inferred that with the combination of CTT and iRT, we can gain insights about the quality of the examination and test behaviors of the students, which can provide us with more powerful tools to improve them.

The relationship between classical item characteristics and item response time on computer-based testing / 한국의학교육

PURPOSE@#This study investigated the relationship between the item response time (iRT) and classic item analysis indicators obtained from computer-based test (CBT) results and deduce students' problem-solving behavior using the relationship.@*METHODS@#We retrospectively analyzed the results of the Comprehensive Basic Medical Sciences Examination conducted for 5 years by a CBT system in Dankook University College of Medicine. iRT is defined as the time spent to answer the question. The discrimination index and the difficulty level were used to analyze the items using classical test theory (CTT). The relationship of iRT and the CTT were investigated using a correlation analysis. An analysis of variance was performed to identify the difference between iRT and difficulty level. A regression analysis was conducted to examine the effect of the difficulty index and discrimination index on iRT.@*RESULTS@#iRT increases with increasing difficulty index, and iRT tends to decrease with increasing discrimination index. The students' effort is increased when they solve difficult items but reduced when they are confronted with items with a high discrimination. The students' test effort represented by iRT was properly maintained when the items have a 'desirable' difficulty and a 'good' discrimination.@*CONCLUSION@#The results of our study show that an adequate degree of item difficulty and discrimination is required to increase students' motivation. It might be inferred that with the combination of CTT and iRT, we can gain insights about the quality of the examination and test behaviors of the students, which can provide us with more powerful tools to improve them.

The revision of the ethical codes and guidelines of the Korean Medical Association

No abstract available.

Analysis of Trends in Self-assessment of Performance of Clinical Skills in Nursing Students after OSCE / 기본간호학회지

PURPOSE: The self-assessment ability of students is important in acquiring clinical skills. The study explored the self-assessment behavior of nursing students after OSCE (Objective Structured Clinical Examination). METHODS: The participants were 90 nursing students. They assessed their performance just after an OSCE (assessment 1). They were given OSCE checklists and re-assessed their performance level (assessment 2). Assessments 1, 2, and an assessment by professor were compared and analyzed. RESULTS: Students assessed themselves higher than professor. But, when students were divided into three groups according to score level, different behaviors were evident between the groups. The high-score group assessed themselves lower than the professor, while the mid-and low-score groups assessed themselves higher than the professor. Students' self-assessment more closely approximated the professor's assessment when they were given checklists. The correlation between assessments 1 and 2 was stronger in high-score group and weak in low-score group. CONCLUSION: The study results indicate that students tend to assess their skills higher than the professor, but their scores were more in line with the professor when they were provided with checklists, and students' self-assessment behavior differed in the different score groups, suggesting a need for customized feedback and a concern for students with low scores.

The Diagnosis and Prognosis of Impingement Syndrome in the Shoulder with Using Quantitative SPECT Assessment: A Prospective Study of 73 Patients and 24 Volunteers

BACKGROUND: Diagnosing impingement syndrome without rotator cuff tear usually depends on the physical examination and roentgenography, and obtaining objective evidence for this condition is at best difficult. The purpose of this study was to ascertain whether quantitatively assessing this condition with using single photon emission computerized tomography (SPECT) can diagnose impingement syndrome and predict the postoperative results. METHODS: Before executing arthroscopic or open treatment, SPECT was performed on 73 patients and 24 volunteers and these people were followed up for 2 years. Any increased uptake on SPECT was investigated by using the axial view, which demonstrated the greatest uptake for the acromion, distal clavicle, greater tuberosity, lesser tuberosity and the coracoid process of the operated and non-operated sides. RESULTS: The patients who were diagnosed as having impingement syndrome with or without rotator cuff tear showed increased uptake on the operative side compared to the non-operated side in the assessed locations. The greater tuberosity of the humerus could be used for quantitative measurement as a postoperative prognostic factor. CONCLUSIONS: The bone SPECT method is useful for making the diagnosis of patients with impingement sydrome, and the results of quantitative assessment at the greater tuberosity can be used for evaluating the prognosis following the operation.

The Effects of Wearing Protective Devices among Residents and Volunteers Participating in the Cleanup of the Hebei Spirit Oil Spill / 예방의학회지

OBJECTIVES: To assess the protective effects of wearing protective devices among the residents and volunteers who participated in the cleanup of the Hebei Spirit oil spill. METHODS: A total of 288 residents and 724 volunteers were surveyed about symptoms, whether they were wearing protective devices and potential confounding variables. The questionnaires were administered from the second to the sixth week following the accident. Spot urine samples were collected and analyzed for metabolites of 4 volatile organic compounds (VOCs), 2 polycyclic aromatic hydrocarbons (PAHs), and 6 heavy metals. The association between the wearing of protective devices and various symptoms was assessed using a multiple logistic regression adjusted for confounding variables. A multiple generalized linear regression model adjusted for the covariates was used to test for a difference in least-square mean concentration of urinary biomarkers between residents who wore protective devices and those who did not. RESULTS: Thirty nine to 98% of the residents and 62-98% of volunteers wore protective devices. Levels of fatigue and fever were higher among residents not wearing masks than among those who did wear masks (odds ratio 4.5; 95% confidence interval 1.23-19.86). Urinary mercury levels were found to be significantly higher among residents not wearing work clothes or boots (p<0.05). CONCLUSIONS: Because the survey was not performed during the initial high-exposure period, no significant difference was found in metabolite levels between people who wore protective devices and those who did not, except for mercury, whose biological half-life is more than 6 weeks.

Differences between Scores Assessed by Examiners and Examinees on Objective Structured Clinical Examination / 한국의학교육

PURPOSE: Self-assessment is important for learning. But, the reliability of self-assessment has long been questioned. We investigated this problem in an objective structured clinical examination (OSCE) setting. METHODS: Forty third-year nursing students who participated in the OSCE were given the same checklist that was used for assessment by the examiners after they finished the OSCE. Then, the scores that were calculated by the examiners and examinees were compared, measuring the average, correlation, difference in score between examinee and examiner, difference in score according to the examinee's level, and Z-score. RESULTS: Scores that were made by the examinees were significantly higher than those of the examiners (average 72.34 vs. 64.03), between which there was a loose positive correlation (r=0.34). The correlation coefficient increased (r=0.62) when a difference in score (examinee-examiner) was compared with the examiner score. When examinees were divided into 3 groups according to their scores, the difference tended to become less as the scores of examinee rose. When the Z-score was compared with the level of the examinee, examinees who had higher scores evaluated themselves lower than the examiners, and examinees with lower scores assessed themselves higher than the examiners. CONCLUSION: According to comparison of averages or correlation analysis, self-assessment by the examinee appeared to be less reliable. But when data were analyzed using difference in score, examinee levels, and Z-score, a certain tendency developed. This pattern may be due to the heterogeneity of the examinee group. Selection of appropriate analysis methods might be important to estabilish the reliability of self-assessment skills.

Effective Half-life of I-131 in Patients with Differentiated Thyroid Cancer Treated by Radioactive I-131 / 핵의학분자영상

PURPOSE: Effective half life of I-131 (T(eff)) in patients with differentiated thyroid cancer treated by I-131 is must-know value for dose calculation and determination of release time from isolation room. There has been no report about T(eff) in Koreans. Thus, author tried to measure dose rate without radiation exposure to faculty members and calculated T(eff). METHODS: Probe of radiation survey meter was fixed at the wall of isolation room, and body of survey meter was placed outside the room. With this simple arrangement, author could measure radiation frequently without radiation exposure to faculty members in 68 patient (F=55, M=13, age=47+/-13.7) treated by I-131 (3.7~7.4 GBq) for differentiated thyroid cancer from Jan 2006 to Dec 2006. From this data, T(eff), 48 hr retention rate, and the time necessary to whole body retention of I-131 become less than 1.1 GBq were calculated. Serum creatinine levels were measured before and after thyroid hormone withdrawal. RESULTS: T(eff) was 15.4+/-4.3 hr (9.4~32.5 hr). There was a loose correlation between T(eff) and serum creatinine concentration (r=0.45). 48hr retention was 4.9+/-4.2% (1~23%). Time necessary to whole body retention of I-131 become less than 1.1 GBq was calculated as 47.1+/-13.2 hr for 9.25 GBq, 42.1+/-11.9 hr for 7.4 GBq, 35.7+/-10.0 hr for 5.55 GBq, and 26.7+/-7.5 hr for 3.7 GBq dose of I-131. CONCLUSION: Author successfully measured radiation dose rates in isolated patients treated by high dose of I-131 without radiation exposure to the faculty members with simple arrangement of survey meter probe. Using those data, T(eff) and some other indices were calculated.

A Case of Primary Pulmonary Artery Sarcoma Mimicking Pulmonary Embolism: Role of PET/CT for Differential Diagnosis / 결핵및호흡기질환

Primary pulmonary artery sarcoma is a rare malignant tumor arising from the pulmonary artery. Diagnosis of primary pulmonary artery sarcoma is quite difficult and the conditon is often misdiagnosed as a more common disease, such as a pulmonary embolism. PET can help in diagnosing a pulmonary artery sarcoma due to the increased uptake of 18F-FDG in the area of the tumor. However, the poor anatomic resolution of PET has limited its clinical applications in pulmonary vascular disease. The recently developed PET/CT is the fusion of PET and CT that improves the anatomical resolution of PET. We report a case of a primary pulmonary artery sarcoma mimicking a pulmonary embolism that was diagnosed with PET/CT and confirmed with a surgical resection.

Assessment of Ventricular Function Using Gated Blood Pool Scan and Gated Blood Pool SPECT / 대한핵의학회잡지

Non-invasive evaluation of cardiac function by nuclear medicine technologies are one of the major contribution of nuclear medicine. Gated cardiac blood pool scan was once a novel and robust technique which enabled evaluation of ventricular function. Concept of EKG gating was one of the major breakthrough in nuclear cardiology. According to the evolution of echocardiographic techniques, and as the evaluation of myocardial perfusion by perfusion SPECT became feasible, number of gated blood pool study done in nuclear medicine laboratory is declining. And recently, evaluation of ventricular function with gated perfusion SPECT further decreased the use of gated blood pool scan. In this article, assessment of ventricular function using gated blood pool scan is discussed including some insight about the role of gated blood pool SPECT.

The Effect of Low Energy Laser Irradiation on the Sciatic Nerve Regeneration of the Rat

OBJECTIVE: To verify the effect of low energy laser irradiation (LELI) on the regeneration of injured sciatic nerve of the rat by showing the functional improvement and the elevated immunoreactivities (IRs) of growth-associated protein 43 (GAP-43). METHOD: Twenty rats, which had standardized compression injuries to the sciatic nerves, received the calculated LELI therapy immediately after the nerve injury and four consecutive days. The functional status was evaluated by sciatic functional index (SFI), and GAP-43-IRs was evaluated by immunohistochemistry and RT-PCR. RESULTS: The SFI was recovered in LELI rats faster than in the control group. Although expression of GAP-43 in the injured sciatic nerve was increased both in the LELI and control groups, the intensities of GAP-43-IRs were much greater in LELI treated group at 1 and 3 weeks after nerve injury. Both SFI and GAP-43-IRs reached the same level at 5 weeks after the nerve injury. CONCLUSION: LELI enhanced the neural regeneration after experimentally induced sciatic nerve injury at the early stage of recovery. Considering the effect of LELI on nerve regeneration was not fully explained until now, this study could suggest the meaningful explanation on the mechanism of LELI effectiveness on neural regeneration.

Result of Mid-Term Evaluation in Internal Medicine Clinical Clerkship in One Medical School / 한국의학교육

PURPOSE: To know the current status and to improve the internal medicine clinical clerkship in one medical school, the author performed a mid-term survey of the students. METHODS: Questions were given to 48 students at the midpoint of their internal medicine clinical clerkship. Questions were about understanding the of purpose of the rotation, ability to do physical examination and procedures, bedside teaching experience and conferences, and support during clinical clerkship. Questions used 5-point Likert scale. 48 of 48 students responded. Average points for each question were calculated, and similar free answers were categorized together. RESULTS: Students began their clinical clerkship with high expectations, but soon fell into a 'busy but know-nothing' state. The purpose of the clinical clerkship was not clearly outlined. Students learned physical examination skills and procedures not directly from instructors but by watching over-the-shoulder. Bedside teaching was, in fact, 'table side' teaching. Instructors did not provide immediate feedback at the bedside on how the student gathered information from patients, Students attended conferences targeted towards residents, and they could not understand the ensuing discussions. Students had no sense of belonging to the ward team. This result was reported during a medical grand round with simple short-term strategies, which could be performed easily, and with longer-term strategies requiring more resources. CONCLUSION: The author did a mid-term survey of a clinical clerkship and reported the result with suggested strategies for improvement. The result was distributed to the faculty at other departments as well. Although there was resistance to the suggestions from the internal medicine department, this report was used to initiate clinical clerkship improvement to the clerkship in other departments. The author discusses this result along with a literature review. This paper can be a good resource for medical schools wanting to evaluate and improve their clinical clerkship.

Improvement of Underlying Cause of Death Determination Using Health Related Data Bases from Death Certificates in Which Causes of Death Recorded as Cardiopulmonary Arrest, Nonspecific Symptom, Senility / 대한의료정보학회지

We performed this study to show that it is possible to identify underlying causes of de ath not identif ied by issued death certificates by mapping and adding information from National Database(DB) such as health insurance DB or KUHDDS(Korea Uniform Hospital Discharge Data Sets) with death certificates. We collected 2,986 death certificates issued at Cheonan, Asan provinces and 458 death certificates issued at 3 general hospitals at Chenoan city. Mapping of death certificate data with health insurance DB was possible in 77.4%(Cheonan, Asan provinces) and 87.3%(3 general hospitals at Cheonan city) of cases. Rate of underlying causes of death identified from records on death certificates before mapping was 64.4% and 68.3% each. After mapping and adding information from health insurance DB, the rate increased to 79.8% and 79.2% each. This work was done by skilled medical record officers. We also selected death certificates which recorded the causes of deaths as old age, cardiopulmonary arrest, or nonspecific symptoms. The possibility was shown that old age, ca rdiopulmonary a rrest, and nonspecific symptoms can be corrected by information from mapped health insurance DB and KUHDDS. With these results, we discussed some cause of incorrect recording practices. And we suggested simple but practical method to improve the correctness of death certificates; there is a possibility that comparing death certificates with KUHDDS before it is issued, where available, can improve the quality of death certificate.

Student's Response to Current Lecture Evaluation Method in One Medical School / 한국의학교육

PURPOSE: The evaluation of a lecture by students is one of the good way to improve a lecture. In one medical school, we started one-year-integrated-lecture curriculum for sophomore. And we evaluated lectures using formal lecture evaluation sheet after completion of each integrated lectures. The results were fed back to lecturers. But lecturers were indifferent to the results. So we performed this study to evaluate the current lecture evaluation method. METHODS: Answering patterns of evaluation sheets were reviewed. 50 students entitled to integrated lectures were given structured questions. 44 of them recovered. And randomly selected 10 students were interviewed. RESULTS: Analysis of evaluation sheets showed that some students checked the items just for fun. More than half of the students answered that they did not check the questions seriously. Reasons why the evaluation of lectures were not going well were; students were not trained to evaluate something; evaluation sheet was not designed to evaluate individual lecturer; listed items were too many in number and inappropriate; some students were suspicious about the impact of evaluation of lectures. In addition to this, it was revealed that students thought the timing of evaluation of lecture was important, too. CONCLUSION: Indifference of lecturers to the results is one form of resistance to the evaluation of lectures by students. To make evaluation of lectures effective, numbers and contents of evaluation items must be selected carefully, students need to be trained, and adequate evaluation timing should be determined with frequent feed backs.

Two Cases of Acquired Hypothyroidism with Severe Obesity, Short Stature and Cardiomegaly / 대한소아내분비학회지

The clinical signs of acquired hypothyroidism are usually manifested insidiously over several months to years. The incidence increases after 6 years of age and peaks at 11 to 18 years of age. The clinical symptoms and signs are fatigue, constipation, decreased growth velocity and delayed bone age, compromised intellectual performance, obesity, myxedema, hyperlipidemia, peripheral neuropathy and delayed or precocious puberty. Two children were referred to our hospital for the evaluation of severe obesity and short stature. During the evaluation we found they also had hyperlipidemia, cardiomegaly with or without pericardial effusion. Thyroid function test revealed decreased serum thyroid hormone levels with positive anti- microsome and anti-thyroglobulin antibodies consistent with long-standing acquired hypothyroidism. After the supplement of L-thyroxine, both of them showed rapid improvement of above symptoms, except for the incomplete catch-up growth. We herein report two cases of acquired hypothyroidism with severe obesity, short stature, hyperlipidemia and cardiomegaly with review of literatures.

Two Cases of Acquired Hypothyroidism with Severe Obesity, Short Stature and Cardiomegaly / 대한소아내분비학회지

The clinical signs of acquired hypothyroidism are usually manifested insidiously over several months to years. The incidence increases after 6 years of age and peaks at 11 to 18 years of age. The clinical symptoms and signs are fatigue, constipation, decreased growth velocity and delayed bone age, compromised intellectual performance, obesity, myxedema, hyperlipidemia, peripheral neuropathy and delayed or precocious puberty. Two children were referred to our hospital for the evaluation of severe obesity and short stature. During the evaluation we found they also had hyperlipidemia, cardiomegaly with or without pericardial effusion. Thyroid function test revealed decreased serum thyroid hormone levels with positive anti- microsome and anti-thyroglobulin antibodies consistent with long-standing acquired hypothyroidism. After the supplement of L-thyroxine, both of them showed rapid improvement of above symptoms, except for the incomplete catch-up growth. We herein report two cases of acquired hypothyroidism with severe obesity, short stature, hyperlipidemia and cardiomegaly with review of literatures.

A Case of Hepatopulmonary Syndrome Diagnosed by 99mTc - MAA Perfusion Lung Scan / 대한핵의학회잡지

No abstract available.

Osteitis in Patients with Chronic Paranasal Sinusitis Evaluated by 99mTc-MDP bone SPECT / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The objective of this study is to investigate the incidence and clinical implication of osteitis in patients with chronic paranasal sinusitis. MATERIALS AND METHODS: Forty three patients diagnosed as chronic paranasal sinusitis were examined with 99mTc-MDP bone SPECT preoperatively and underwent endoscopic operation, and 6 volunteers were recruited and examined as a control group. Each SPECT image was semiquantitatively assigned one of three grades of 0, 1, 2 according to intensities of isotope uptake. Quantitative analysis of the uptake of the isotope was performed by computer. The incidence of osteitis was analyzed. The correlation between semiquantitative grades and quantitative uptake indices was evaluated, and degree of isotope uptake and the severity of mucosal pathology on CT was correlated. The degree of isotope uptake between the patients who had recurrence and had not was compared. RESULTS: Quantitative evaluation of uptake indices were significantly higher in the patient group than in the control group. Marked uptakes of isotope on the sinus areas, suggesting the presence of osteitis, were shown in the patient group by 53.5%. The semiquantitative grades and quantitative indices showed positive correlation, and SPECT and CT scan findings also showed significant correlation. The uptake indices of patients who had recurrence were significantly higher than those of patients who showed no recurrence in both ethmoid sinus areas. CONCLUSIONS: The results of this study showed that significant proportion of patients with chronic paranasal sinusitis have osteitis, and patients with more severe osteitis represent poorer postoperative courses.