Comparison of clinical medicine proficiency tests of China and Japan and the enlightenment / 中华医学教育探索杂志

The Clinical Medicine Proficiency Test developed by the National Medical Examination Center of China in 2020 aims to assess whether clinical medical students possess the necessary medical humanities and basic medical theoretical knowledge and skills required for clinical internships. Since 2002, Japan has implemented the pre-clinical clerkship objective structured clinical examination and computer-based testing, which share similarities with China's proficiency test in terms of examination objectives, content, format, and score evaluation. Through comparing the examinations of China and Japan, this article concludes that it is necessary to learn from Japan's experience to expedite the process of promoting the Clinical Medicine Proficiency Test as an industry admission examination in China. We suggest that medical schools should keep tracking the development of the proficiency test and fully leverage its role in urging students to pay more attention to clinical internships. We also urge medical schools to establish a three-level examination system based on post competency criteria in line with the standards of the National Medical Licensing Examination to improve the quality of medical education.

Some thoughts on compulsory licensing of pharmaceutical patents in emergency situations / 药学实践与服务

Objective To explore the conditions for compulsory licensing of pharmaceutical patents and the steps for implementing compulsory licensing of pharmaceutical patents. Methods The current situation and problem of compulsory licensing of pharmaceutical patents in China were analyzed by collecting the relevant laws and regulations in China, United States, India, and the World Trade Organization. The feasible practices of compulsory licensing of pharmaceutical patents among the other countries and organizations were compared. Results China needs to improve the system of compulsory licensing of pharmaceutical patents, clarify the implementation details, strengthen policy guidance, and encourage cooperation between government and enterprises to ensure the smooth implementation in emergency situations. Conclusion Compulsory licensing system and implementation rules in China for pharmaceutical patents should be supplemented and improved by absorbing the useful provisions of international organizations and relevant countries, so as to achieve the pharmaceutical supply in emergency situations and meet the needs of public health.

Analysis of the effects of the teaching reform to strengthen the integration of basic medicine and clinical medicine through the National Medical Licensing Examination scores / 中华医学教育探索杂志

Objective:To investigate the effects of teaching reform to strengthen the integration of basic medicine and clinical medicine by analyzing the scores of the National Medical Licensing Examination from 2014 to 2018.Methods:Through the improvement of the training program, the establishment of subject integration courses, the standardization of case teaching mode and the establishment of comprehensive medical experiment courses, the teaching reform of the combination of basic medicine and clinical medicine was carried out. The differences in the scores of the National Medical Licensing Examination between the students from Dalian University and those from the whole country were compared, including the average total scores, the passing rates, the average mastery rates of the basic medicine, and the average mastery rates of the cognitive level of the basic medicine.Results:In 2014, 2015 and 2016, the average total scores of the students from Dalian University were 384.70±53.62, 395.45±50.49, and 401.43±50.88, respectively, which were lower than those from the whole country (396.15±58.85, 400.78±56.88, and 405.15±58.06). The average mastery rates of the basic medicine of the students from Dalian University were 56.28%, 62.45%, and 64.92%, respectively, lower than those from the whole country (58.41%, 62.46%, and 65.36%). The average mastery rates of the basic medicine of the students form Dalian University from 2014 to 2016 were lower than those from the whole country, and those were higher in 2017 to 2018 than the whole country. The average total scores of the students form Dalian University in 2017 and 2018 were 397.11 and 400.26 ± 61.15, respectively, higher than those from the whole country (388.91 and 397.01±58.35). The average mastery rates of the basic medicine of the students form Dalian University were 61.53% and 59.85%, respectively, higher than those from the whole country (58.64% and 58.38%). The total passing rates of the students from Dalian University in 2014 and 2016 were 91.11% and 72.73%, respectively, lower than those from the whole country (91.18% and 73.75%), while in 2015, 2017 and 2018 those were 76.47%, 77.78%, and 77.59%, respectively, all higher than those from the whole country (73.59%, 74.29%, and 76.89%). All the data showed a trend of increase with the teaching reform process.Conclusion:Strengthening the teaching reform of the combination of basic medicine and clinical medicine during the learning stage of basic medicine could improve students' learning interest and attention to the basic medical knowledge, strengthen the understanding of the relevance of basic medicine to clinical medicine, and play a positive role in the cultivation of medical students' post competency and the achievement of the goal of training applied medical talents.

Challenges and reflections on the final theoretical examination of Chinese undergraduate medical education in the context of organ-system based integrated curriculum / 中华医学教育探索杂志

In order to solve the problems faced by final theoretical examination in the context of organ-system based integrated curriculum, this article analyzes the challenges and demands placed on the final theoretical examination of organ-system based integrated curriculum in undergraduate medical education, and it is pointed out that traditional medical theoretical examinations cannot meet these new demands since they are mainly memorized questions with one knowledge point for each question, as well as a lack of multidisciplinary knowledge fusion. By analyzing the questions in the United States Medical Licensing Examination (USMLE) test, this article summarizes the features of final theoretical examination suitable for organ-system based integrated curriculum and proposes that the final theoretical examination of organ-system based integrated curriculum suitable for Chinese undergraduate medical education can be developed through the translation of USMLE test, item modeling technique, or writing new tests based on the classification of knowledge points. The reform of final theoretical examination in the context of organ-system based integrated curriculum may help to realize the aim and objective of integrated teaching.

Application and effects of objective structured clinical examination in the clinical ability assessment of stomatology undergraduates / 中华医学教育探索杂志

Objective:To explore the objective structured clinical examination (OSCE) on the improvement of clinical competence of stomatology undergraduates, and to promote their ability and skills of taking the National Medical Licensing Examination (NMLE).Methods:The OSCE was implemented to evaluate the clinical skills of stomatology undergraduates from Batch 2009 to Batch 2012. The OSCE results were analyzed and compared with the NMLE (Stomatology) results on the correlation coefficient analysis of annual passing rate.Results:The passing rate of practical skills in the NMLE (Stomatology) of Batch 2009 to Batch 2012 stomatology undergraduates was basically consistent with the excellent rate of OSCE, and the correlation coefficient was 0.94.Conclusion:It has not been proved that the OSCE assessment organized by our school can increase the passing rate of practical skills in the NMLE, but it has certainly helped students better understand and apply theoretical knowledge, and it plays a positive role in promoting students' future development.

Proposta de critérios norteadores e requisitos mínimos para licenciamento ambiental de usinas fotovoltaicas no Brasil / Proposal of criteria and minimum requirements for environmental licensing of photovoltaic power plants in Brazil

RESUMO A geração de energia fotovoltaica vem crescendo no Brasil, e a capacidade instalada de usinas fotovoltaicas (UFV) deve superar 3 GW em alguns anos. Essa tecnologia causa menor impacto ambiental do que formas de geração tradicionais, como termoelétricas e hidroelétricas. Entretanto os impactos quando da implantação de UFV devem ser considerados no licenciamento ambiental. No Brasil, não há uma legislação federal que estabeleça critérios mínimos para esse tipo de licenciamento. Alguns estados criaram legislações próprias, que divergem nas exigências e critérios adotados. Essa disparidade causa insegurança no processo de licenciamento, dificuldade na aprovação dos estudos, aumento de custos e prazos, podendo inviabilizar empreendimentos. Neste estudo foram analisadas e comparadas as legislações em 12 estados, nas quais está previsto o desenvolvimento de UFV, como base para propor critérios claros, objetivos e padronizados para o enquadramento legal das UFV. Como resultado desta pesquisa, propõe-se o enquadramento como de baixo impacto, com licenciamento simplificado e emissão de licença prévia (LP) e licença de instalação (LI) em etapa única. Os critérios para enquadramento de porte são potência instalada e área diretamente ocupada. Para potencial poluidor, os critérios são necessidade de supressão de vegetação nativa (e/ou em área de preservação permanente - APP) e localização em área de fragilidade socioambiental. A avaliação conjunta desses critérios define qual o estudo ambiental necessário ao licenciamento. O trabalho lista os principais aspectos e impactos ambientais a serem abordados em tais estudos. Estes critérios unificados formam uma ferramenta para promover tanto o desenvolvimento de UFV como a proteção do meio ambiente com minimização de possíveis impactos.

ABSTRACT Photovoltaic power generation is growing in Brazil. It is expected that installed capacity of photovoltaic power plants (PVPP) will exceed 3 GW within a few years. This technology is known to have less environmental impacts than other traditional forms of energy generation, however its environmental impacts should be considered in the environmental licensing process. In Brazil there is no federal legislation establishing the criteria or requirements for licensing this type of power plants. Some states have created their own legislation, whose criteria differ widely. This lack of national standardization causes licensing agencies' insecurity, difficulty in approving studies, increase in costs and deadlines, and has caused many projects to be unfeasible. Therefore, this study did an analysis and comparison of 12 states' legislation regarding environmental licensing of PVPPs. This analysis based the proposal of clear, objective and standardized criteria for PVPPs licencing. It is proposed to normally classify the PVPPs as having low environmental impact, with simplified licensing, issuing Preliminary and Installation License in a single step. The proposed criteria for classification in size are installed power and directly occupied area. Regarding the pollution potential, the criteria are suppression of native vegetation (and/or in a permanent preservation area); and location in environmental fragile areas. The joint evaluation of these criteria defines the type of environmental study to be required for licensing. The main aspects and environmental impacts that should be addressed are listed. These unified criteria are a tool to promote both development of PVPP projects and the protection of the environment, by minimizing their potential environmental impacts.

Exames de licenciamento em Medicina - uma boa ideia para a formação médica no Brasil? / Medical licensing examinations - are they a good idea for medical education in Brazil? / Exámenes de licencia en Medicina - ¿Una buena idea para la formación médica en Brasil?

A sociedade brasileira vem discutindo, recentemente, a ideia de implementar um exame de licenciamento em Medicina (ELM) para médicos recém-formados no país. Para avaliar a adequação dessa proposta e sua real necessidade, analisa-se neste trabalho se os ELMs estabelecem eficazmente a aptidão dos recém-formados para exercer a Medicina e se os sistemas de avaliação vigentes no ensino médico brasileiro já o fazem. Usando o modelo baseado em competências como referencial, discute-se a experiência da comunidade internacional com os ELMs e as características das avaliações que se propõem a medir, no Brasil, a aptidão dos recém-formados. Conclui-se que, isoladamente, ambas as alternativas são ineficazes para cumprir esse objetivo. Propõe-se o desenvolvimento de um programa mais amplo de avaliação e enfatiza-se a importância da colaboração entre os atores envolvidos para aprimorar a qualidade das avaliações dos médicos recém-formados no Brasil.(AU)

The introduction a medical licensing examination (MLE) for the country's newly qualified doctors has been the subject of discussion recently in Brazil. To assess the suitability of and real need for this test, this article analyzes whether the MLE provides an effective measure of the aptitude of newly qualified doctors and whether the evaluation system currently in place in medical education already does this. Using a competency-based model, we discuss experiences with MLEs in other countries and the features of the examinations proposed in Brazil to measure the aptitudes of newly qualified doctors. It is concluded that, in isolation, both alternatives are inadequate. We propose the development of a broader assessment program and stress the importance of collaboration between the different actors involved in order to enhance the quality of the examinations proposed to test the aptitude of newly qualified doctors in Brazil.(AU)

La sociedad brasileña ha discutido recientemente la idea de implementar un examen de licencia (ELM) para médicos recién graduados en el país. Para evaluar la adecuación de esta propuesta y su real necesidad, se analiza en este trabajo si los ELMs establecen eficazmente la aptitud de los recién graduados para ejercer la Medicina y si los sistemas de evaluación vigentes en la enseñanza médica brasileña ya lo hacen. Usando el modelo basado en competencias como factor referencial, se discute la experiencia de la comunidad internacional con los ELMs y las características de las evaluaciones que se proponen medir, en Brasil, la aptitud de los recién graduados. Se concluye que, aisladamente, ambas alternativas son ineficaces para cumplir ese objetivo. Se propone el desarrollo de un programa más amplio de evaluación y se enfatiza la importancia de la colaboración entre los actores envueltos para perfeccionar la calidad de las evaluaciones de los recién graduados en Brasil.(AU)

Sustentabilidade do licenciamento ambiental minerário em Minas Gerais: caso aplicado / Sustainability of the mineral environmental licensing in Minas Gerais: case applied

RESUMO A avaliação de impactos ambientais, introduzida por meio da Política Nacional de Meio Ambiente (PNMA), ganhou espaço primordialmente dentro do licenciamento ambiental, cujo modelo atual é questionado pela sua ineficácia em compensar ao ambiente a perda dos recursos naturais. Este estudo teve como objetivo analisar de forma técnica e legal o licenciamento ambiental minerário na Região do Alto São Francisco, Minas Gerais, por intermédio do histórico e fluxo atual dos processos, do levantamento de dados dos de Estudos de Impacto Ambiental, do cumprimento dos Termos de Referência e da legislação ambiental, analisando estes dados pelo método Analytic Hierarchy Process (AHP). Os resultados demonstraram que o licenciamento ambiental não cumpre a função de compensar os impactos socioambientais causados pela atividade nem os requisitos legais obrigatórios ao processo.

ABSTRACT The assessment of environmental impacts, introduced by the National Environmental Policy, has earned a place within the environmental licensing process, which is currently questioned due to its ineffectiveness to compensate nature for resources' loss. This study aimed at technically and legally assessing the mineral environmental licensing process in the Region of Alto São Francisco, Minas Gerais, through history and current flow of processes, as well as by surveying data from Studies on Environmental Impact, and compliance with the Terms of Reference and applicable environmental law, using the Analytic Hierarchy Process (AHP). The results showed that the environmental licensing process does not meet the needs for compensating the socioenvironmental impacts caused by activity and does not comply with the legal requirements that are mandatory in the process.

Análisis crítico e histórico de la calidad de educación médica en el Perú / Critical and historical analysis of the quality of medical education in Peru

Introducción: La política que ha regido la educación superior universitaria en el Perú ha sido variable en el tiempo y su despertar hacia el concepto de calidad es tardío con relación a otros países latinoamericanos. Esta situación se vio agravada en las décadas pasadas por políticas dirigidas a convertir la educación en una empresa rentable con normas poco rígidas para asegurar su calidad. En la actualidad, el Perú se encuentra realizando una reforma de la educación superior universitaria, reformulando sus bases, y tratando de construir estándares de calidad adecuados. Es en este escenario, que hacemos un análisis de los factores que influyen en la calidad de la educación médica, siendo la salud un bien supremo de todos los ciudadanos; y la atención de calidad una responsabilidad compartida entre el Estado y las universidades. Objetivo: Exponer una visión histórica, analítica, crítica y actualizada sobre los aspectos más relevantes a considerar para la mejora de la formación profesional de los médicos en el Perú. Métodos: Se realizó una revisión bibliográfica en la base de datos de MedLine/PubMed, The Cochrane Library y Scielo. Los descriptores utilizados para la búsqueda fueron: educación médica, calidad, acreditación. Las publicaciones y artículos encontrados fueron analizados a profundidad realizándose una síntesis de los mismos. Resultados: Esta revisión permitió identificar las características esenciales y los desafíos a enfrentar por las instituciones de Educación Superior en el ámbito de la educación médica. Esto con fines de lograr la acreditación para asegurar la calidad en la formación de los médicos en el Perú(AU)

Introduction: The policy of university higher education in Peru has been variable over time as well as its progress regarding the concept of quality in relation to other Latin American countries. This situation has worsened in the last decades due to policies aimed at making education profitable, generating companies with few rigid rules to guarantee the quality of education. Currently, Peru is carrying out a reform of university higher education, reformulating its bases and trying to build quality standards. It is in this scenario, that we make an analysis of the factors that influence the quality of medical education, considering health as a supreme good for all citizens and the achievement of quality as a shared responsibility between the State and universities. Objective: To present a historical, analytical, critical and updated view on the most relevant aspects to be considered for the improvement of the professional training of physicians in Peru Methods: A literature review was made in the MedLine / PubMed database, The Cochrane Library and Scielo. The descriptors used for the search were: medical education, quality, accreditation. The found articles were analyzed, making a synthesis of them. Results: This revision has permitted to identify the characteristics and challenges faced by higher medical education institutions to get the accreditation and ensure the quality of the professional training of doctors in Perú(AU)

Research and practice on strengthening the integration of pathophysiology teaching and national medical licensing examination / 中华医学教育探索杂志

The National Medical Licensing Examination has become one of the most important indicator s to measure the teaching quality of medical colleges and universities. In this paper, by analyzing the status of pathophysiology in National Medical Licensing Examination and the current problems existing in pathophysiology teaching, the author proposed a scheme of reform in the pathophysiology teaching based on Medical Licensing Examination, including changing teaching idea, optimizing teaching content, reforming teaching means and adjusting the assessment methods . This reform aims to make the pathophysiology teaching really serve the needs of clinical application.

Analysis and Improvement Suggestions on Change of Medical Devices Licensing Items / 中国医疗器械杂志

Based on the statistics of 350 technical evaluations of changes in licensing items of class Ⅱ passive and active medical devices completed in Henan province from July 2017 to November 2018, this paper summarized and analysed the common problems and requirements listed in the correction notifications of the technical evaluation, and put forward relevant countermeasures or suggestions, with a view to further speeding up the evaluation and approval of medical devices.

Linear programming method to construct equated item sets for the implementation of periodical computer-based testing for the Korean Medical Licensing Examination / 보건의료교육평가

PURPOSE: This study aimed to identify the best way of developing equivalent item sets and to propose a stable and effective management plan for periodical licensing examinations. METHODS: Five pre-equated item sets were developed based on the predicted correct answer rate of each item using linear programming. These pre-equated item sets were compared to the ones that were developed with a random item selection method based on the actual correct answer rate (ACAR) and difficulty from item response theory (IRT). The results with and without common items were also compared in the same way. ACAR and the IRT difficulty were used to determine whether there was a significant difference between the pre-equating conditions. RESULTS: There was a statistically significant difference in IRT difficulty among the results from different pre-equated conditions. The predicted correct answer rate was divided using 2 or 3 difficulty categories, and the ACAR and IRT difficulty parameters of the 5 item sets were equally constructed. Comparing the item set conditions with and without common items, including common items did not make a significant contribution to the equating of the 5 item sets. CONCLUSION: This study suggested that the linear programming method is applicable to construct equated-item sets that reflect each content area. The suggested best method to construct equated item sets is to divide the predicted correct answer rate using 2 or 3 difficulty categories, regardless of common items. If pre-equated item sets are required to construct a test based on the actual data, several methods should be considered by simulation studies to determine which is optimal before administering a real test.

Analysis of the influence of the first stage examination of clinical practitioner qualification on the education and teaching of provincial medical univrsities / 中华医学教育探索杂志

First-period examination in empirical study of clinical medical national licensing staged examination has been implemented for two years in Binzhou Medical University (BZMU).During the examination,BZMU obtained the experience of organization,guarantee,and training,which adopted corresponding reform measures including course teaching,assessment method,incentive reward and punishment,etc.The first-period examination of staged examination is national examination of quality of education and teaching on the university,which has promoting effect to strengthen the core of the education teaching and renew the idea of teachers' teaching evaluation.It can improve the evaluation system of curriculum assessment and promote students correctly using the theoretical knowledge to clinical practice skills and improve alignment between the university and hospital.Finally,it can promote the reform and development of medical education.

Comparison of results between modified-Angoff and bookmark methods for estimating cut score of the Korean medical licensing examination / 한국의학교육

PURPOSE: The purpose of this study was to apply alternative standard setting methods for the Korean Medical Licensing Examination (KMLE), a criterion-referenced written examination, and to compare them to the conventional cut score used on the KMLE. METHODS: The process and results of criterion-referenced standard settings (i.e., the modified-Angoff and bookmark methods) were evaluated. The ratio of passing and failing examinees determined using these alternative standard setting methods was compared to the results of the conventional criteria. Additionally, the external, internal and procedural evaluation of these methods were reviewed. RESULTS: The modified-Angoff method yielded the highest cut score, followed sequentially by the conventional method and the bookmark method. The classification agreement between the modified-Angoff and bookmark methods was 0.720 measured by Cohen's κ coefficient. The intra-panelist classification consistency of modified-Angoff method was higher than bookmark method. However, the inter-panelist classification consistency was vice versa. The standard setting panelists' survey results showed that the procedures of both methods were satisfactory, but panelists had more confidence in the results of the modified-Angoff method. CONCLUSION: The modified-Angoff method showed results that were more similar to those of the conventional method. Both new methods showed very high concordance with the conventional method, as well as with each other. The modified-Angoff method was considered feasible for adoption on the KMLE. The standard setting panelists responded positively to the modified-Angoff method in terms of its practical applicability, despite certain advantages of the bookmark method.

The Influence of Income Level and Remuneration Scheme on Job Satisfaction among Professional Driving Instructors in Malaysia

This study aims to determine the job satisfaction (JS) level among professional driving instructors (PDIs) in the drivertraining and licensing system in Malaysia. Specifically, it looks at the influence of income level and remunerationscheme on PDI’s satisfaction. The average income of PDI is relatively low with three remuneration schemes: fixedincome; fixed income plus commission; and commission only. The study adopted the cross-sectional survey using the20-item Minnesota Job Satisfaction Questionnaire (MSQ) (short-form) with end-specified 10-point scale. Analysis ofthe data revealed that PDIs with higher income are more satisfied with their job, t (179) = -3.248, p = 0.001.Similarly, three level One-way ANOVA of JS scores with three remuneration schemes revealed a significant differenceof JS across these schemes, F (2,178) = 3.51, p ≤ 0.032. Researchers’ further exploration found a significantinteraction between these two variables (income level vs. remuneration scheme), F (5,175) = 4.88, p = 0.001. Ingeneral, PDIs with higher income are more satisfied with their job only if they received it as a fixed income(regardless of having commission or not). This insightful finding can be a basis for relevant stakeholders inunderstanding the influence of income and remuneration scheme towards JS among PDIs in Malaysia.

The Influence Of Income Level And Remuneration Scheme On Job Satisfaction Among Professional Driving Instructors In Malaysia

@#This study aims to determine the job satisfaction (JS) level among professional driving instructors (PDIs) in the driver training and licensing system in Malaysia. Specifically, it looks at the influence of income level and remuneration scheme on PDI’s satisfaction. The average income of PDI is relatively low with three remuneration schemes: fixed income; fixed income plus commission; and commission only. The study adopted the cross-sectional survey using the 20-item Minnesota Job Satisfaction Questionnaire (MSQ) (short-form) with end-specified 10-point scale. Analysis of the data revealed that PDIs with higher income are more satisfied with their job, t (179) = -3.248, p = 0.001. Similarly, three level One-way ANOVA of JS scores with three remuneration schemes revealed a significant difference of JS across these schemes, F (2,178) = 3.51, p ≤ 0.032. Researchers’ further exploration found a significant interaction between these two variables (income level vs. remuneration scheme), F (5,175) = 4.88, p = 0.001. In general, PDIs with higher income are more satisfied with their job only if they received it as a fixed income (regardless of having commission or not). This insightful finding can be a basis for relevant stakeholders in understanding the influence of income and remuneration scheme towards JS among PDIs in Malaysia.

Avaliação de Impactos à Saúde (AIS): análises e desafios para a Vigilância em Saúde do Brasil / Health Impact Assessment (HIA): analyses and challenges to Brazilian Health Surveillance

Resumo O presente artigo tem como objetivo discutir sobre a Avaliação de Impacto à Saúde (AIS), apontando as principais iniciativas do setor saúde, desafios e perspectivas para a sua aplicação no Brasil. A AIS é uma metodologia preconizada pela OMS já bastante difundida em diversos países, mas com poucas iniciativas no Brasil. As questões de saúde no âmbito dos grandes empreendimentos no país são comumente realizadas de forma pontual nos processos de licenciamento ambiental, diferentemente da AIS que traz uma abordagem integrada, com a participação dos atores sociais no território desde o início do projeto. Trata-se de uma pesquisa de natureza analítica e exploratória. Para tanto, realizou-se uma revisão sistemática sobre o tema, bem como o levantamento de documentos governamentais das principais iniciativas já realizadas pelo Ministério da Saúde, no âmbito da Vigilância em Saúde Ambiental, nos processos de licenciamento de empreendimentos. Buscou-se analisar os principais marcos conceituais, apontando possibilidades para sua aplicação no Brasil, assim como novas perspectivas para atuação do campo da Vigilância em Saúde nessa temática, permitindo que a variável saúde seja avaliada durante as diferentes intervenções de uma política, programa ou projeto.

Abstract This study aims to discuss the Health Impact Assessment (HIA), pointing out the main initiatives of the health sector, challenges and perspectives for its implementation in Brazil. HIA is a methodology recommended by the WHO and is widely used in several countries, but with few initiatives in Brazil. Health issues in the context of large projects are commonly conducted on a timely basis within the environmental licensing processes, unlike HIA, which proposes an integrated approach, with the involvement of social stakeholders in the territory since the beginning of the project. This is an analytical and exploratory research and, thus, a systematic review on the subject was carried out, as well as a survey of government documents on the main initiatives already conducted by the Ministry of Health within Environmental Health Surveillance in the environmental licensing processes of large projects. We sought to analyze the main conceptual frameworks, pointing out possibilities for their implementation in Brazil, as well as new perspectives for Health Surveillance in this area, allowing the health variable to be evaluated during several interventions of a policy, program or project.

Item development process and analysis of 50 case-based items for implementation on the Korean Nursing Licensing Examination / 보건의료교육평가

PURPOSE: The purpose of this study was to improve the quality of items on the Korean Nursing Licensing Examination by developing and evaluating case-based items that reflect integrated nursing knowledge. METHODS: We conducted a cross-sectional observational study to develop new case-based items. The methods for developing test items included expert workshops, brainstorming, and verification of content validity. After a mock examination of undergraduate nursing students using the newly developed case-based items, we evaluated the appropriateness of the items through classical test theory and item response theory. RESULTS: A total of 50 case-based items were developed for the mock examination, and content validity was evaluated. The question items integrated 34 discrete elements of integrated nursing knowledge. The mock examination was taken by 741 baccalaureate students in their fourth year of study at 13 universities. Their average score on the mock examination was 57.4, and the examination showed a reliability of 0.40. According to classical test theory, the average level of item difficulty of the items was 57.4% (80%–100% for 12 items; 60%–80% for 13 items; and less than 60% for 25 items). The mean discrimination index was 0.19, and was above 0.30 for 11 items and 0.20 to 0.29 for 15 items. According to item response theory, the item discrimination parameter (in the logistic model) was none for 10 items (0.00), very low for 20 items (0.01 to 0.34), low for 12 items (0.35 to 0.64), moderate for 6 items (0.65 to 1.34), high for 1 item (1.35 to 1.69), and very high for 1 item (above 1.70). The item difficulty was very easy for 24 items (below −2.0), easy for 8 items (−2.0 to −0.5), medium for 6 items (−0.5 to 0.5), hard for 3 items (0.5 to 2.0), and very hard for 9 items (2.0 or above). The goodness-of-fit test in terms of the 2-parameter item response model between the range of 2.0 to 0.5 revealed that 12 items had an ideal correct answer rate. CONCLUSION: We surmised that the low reliability of the mock examination was influenced by the timing of the test for the examinees and the inappropriate difficulty of the items. Our study suggested a methodology for the development of future case-based items for the Korean Nursing Licensing Examination.

Access management strategy of large medical equipment based on the government function reform and market development effect / 中国卫生政策研究

Based on the relationship between government and market,this paper analyzed the development process of large medical equipment configuration management strategy,and forecasted the trend of management.It is found that the development process of large equipment management in China can be divided into four stages:sprouting stage,management window period,growth stage,and transition period.The management model of the four stages,respectively,are integrated management,market-oriented management,quantitative control-based comprehensive supervision,and legal supervision.As per the analysis of this work,it was found that the sprouting of the regulation of industry standards,training professionals,management efficiency are low;market-oriented led to rapid growth in the number of equipment,with a low configuration efficiency;growth period of the number of regulatory norms of the market and equipment is reasonable to use;and the legal supervision in transition is taking shape.Currently,the lack of rational allocation of large-scale equipment in the hospitals is the main factor leading to market failure.In the legal framework,the government intervention with configuration permits is the major large-scale equipment configuration management model in the future.

Access management strategy of large medical equipment based on the government function reform and market development effect / 中国卫生政策研究

Based on the relationship between government and market,this paper analyzed the development process of large medical equipment configuration management strategy,and forecasted the trend of management.It is found that the development process of large equipment management in China can be divided into four stages:sprouting stage,management window period,growth stage,and transition period.The management model of the four stages,respectively,are integrated management,market-oriented management,quantitative control-based comprehensive supervision,and legal supervision.As per the analysis of this work,it was found that the sprouting of the regulation of industry standards,training professionals,management efficiency are low;market-oriented led to rapid growth in the number of equipment,with a low configuration efficiency;growth period of the number of regulatory norms of the market and equipment is reasonable to use;and the legal supervision in transition is taking shape.Currently,the lack of rational allocation of large-scale equipment in the hospitals is the main factor leading to market failure.In the legal framework,the government intervention with configuration permits is the major large-scale equipment configuration management model in the future.