Ayudantías universitarias: influencia académica percibida en el desempeño en el examen de residencias médicas municipales / Teaching assistants: perceived academic influence on performance in municipal medical residency exams

Introducción: el ejercicio de la docencia universitaria por parte de estudiantes de Medicina ofrecería múltiples beneficios. Sin embargo, no hay evidencia de que mejore el desempeño en los exámenes estandarizados en el posgrado. El objetivo de este estudio fue describir la diferencia de los puntajes en el examen de residencias médicas municipales entre ayudantes y no ayudantes, y evaluar la autopercepción del efecto de ser ayudante sobre el desempeño en dicho examen y sobre las habilidades académicas. Métodos: estudio observacional, descriptivo, de corte transversal, con un muestreo por conveniencia de médicos participantes del examen de residencias médicas municipales de la Ciudad Autónoma de Buenos Aires (CABA) de 2018, a partir del listado oficial. Se excluyeron aquellos a quienes fue imposible contactar, que se negaran a participar o cuya identidad discrepara con la de la persona seleccionada para incluir en el estudio. Resultados: de los 3579 médicos que concursaron en el examen de residencias médicas básicas municipales de CABA 2018, se tomó una muestra aleatoria de 300 sujetos, de los cuales se contactó a 87. De ellos, 20 sujetos cumplían con criterios de exclusión; por lo tanto fueron 67 sujetos los que finalmente participaron del estudio. La proporción de respuestas con respecto a los sujetos que pudieron ser contactados mediante redes sociales fue 77%. El puntaje de examen entre los ayudantes fue de 32,3 ± 5,7 puntos mientras que entre los no ayudantes fue 29,5 ± 6,1 puntos. Entre los ayudantes, el 68% informó percibir que el hecho de haber realizado una ayudantía en el pregrado tuvo un efecto de levemente a muy positivo sobre su desempeño en el examen, un 76% refirió la profundización de conocimientos específicos, el 73% informó una mejoría en sus habilidades comunicacionales y el 59% una mayor capacidad para jerarquizar contenidos. Conclusión: el desarrollo de una actividad docente en el pregrado sería percibida por quienes la desarrollan como una actividad promotora de habilidades comunicacionales y de jerarquización de contenidos y, ulteriormente, como una influencia positiva en el desempeño académico en el examen de residencias médicas municipales. Estas conclusiones deben confirmarse con estudios futuros. (AU)

Introduction: medical students could benefit from teaching university courses. However, there is no evidence showing that this activity improves academic performance on standardized tests in graduate school. The objective of this study was to describe the differences in scores on the municipal medical residency exam between physicians who were teaching assistants and those who weren't, and to evaluate the self-perception of the effect of being a teaching assistant on the performance on this exam and on academic skills in general. Methods: this is an observational, descriptive, cross-sectional study, with a convenience sample of physicians participating in the 2018 municipal medical residency exam of the Autonomous City of Buenos Aires (CABA) based on official lists. Those who could not be contacted, refused to participate, or whose identity diverged from the person selected to include in the study, were excluded. Results: of the 3,579 physicians who participated in the basic municipal medical residency exam in CABA 2018, a random sample of 300 subjects was taken, of which 87 were contacted. Of those, 20 subjects met the exclusion criteria, having 67 subjects finally participating in the study. The proportion of subjects who could be contacted through social networks was 77%. The exam score among physicians who were teaching assistants was 32.3 ± 5.7 points while among the non-teaching assistants it was 29.5 ± 6.1 points. Among the teaching assistants, 68% perceived that the fact of having been a teaching assistant as an undergraduate had a slight to very positive effect on their performance in the exam, 76% referred the deepening of their specific knowledge on the subject they taught, 73% reported an improvement in their communication skills, and 59% referred a greater ability to rank content. Conclusions: undergraduate teaching would be perceived as an activity that promotes communication skills and ability to rank content and, therefore, as a positive influence on academic performance in the municipal medical residency exam. These conclusions need to be confirmed with future studies. (AU)

Impacto de diferentes modalidades de evaluación en el promedio de notas de estudiantes de Medicina: un estudio de intervención no aleatorizado / Impact of different types of evaluation on the average grade of medicine students: a non-randomized interventional study

Introducción: en el proceso de enseñanza-aprendizaje existen múltiples conflictos al momento de seleccionar el tipo de evaluación que debería aplicarse a estudiantes de Medicina. Nuestro objetivo es comparar diferencias en la media de notas de tres modalidades de examen (oral, escrito para desarrollar y preguntas de opción múltiple) para así determinar cómo estas podrían afectar el desempeño de los estudiantes de Medicina en el campo de la Farmacología. Material y métodos: estudio cuasi experimental con una intervención no aleatorizada en una muestra por conveniencia de estudiantes de Medicina. A fin de evaluar diferencias en la media de notas se hizo un análisis ANOVA para muestras pareadas y luego los correspondientes tests de T para muestras pareadas. Resultados: enrolamos inicialmente a 36 estudiantes; 7 fueron excluidos (4 por ausencia y 3 por abandono), y se obtuvieron 29 participantes. La media de notas del examen oral y la de preguntas de opción múltiple fueron ambas significativamente superiores a la del examen escrito para desarrollar (oral vs. escrito: diferencia 1,8 puntos; IC 95% 0,8 a 2,7; p < 0,01; opción múltiple vs. escrito: diferencia 2,1 puntos; IC 95% 1,4 a 2,9; p < 0,01). No hubo diferencias estadísticamente significativas entre las notas medias del examen oral y del examen de preguntas de opción múltiple (p = 0,37). Conclusión: los estudiantes de Medicina obtienen peores notas en el examen escrito para desarrollar en Farmacología, en relación con los exámenes oral y de preguntas de opción múltiple. Esto posiblemente se asocie al hecho de que aquella modalidad es menos frecuentemente empleada en la carrera de Medicina. (AU)

Introduction: in the teaching-learning process, there are many problems in the selection of the most suitable type of exam for evaluating medical students. Our target was to compare differences in the average grade of medical students upon taking three different types of exam (oral, written, and multiple-choice questions) to determine how these different types of exam may affect the performance of medical students in the area of Pharmacology. Material and methods: we conducted a quasi experimental study by applying a non-randomized intervention to a convenience sample of medical students. To evaluate differences in the average grades among three groups, an ANOVA analysis was applied followed by paired T-tests. Results: we initially enrolled 36 students; 7 were excluded (4 were absent and 3 abandoned the intervention), arriving at a total sum of 29 participants. The average grades of the oral exam and multiple-choice questions were both significantly higher than the written exam (oral vs. written: difference 1.8 points; 95%CI 0.8 to 2.7, p < 0.01; multiple-choice vs. written: difference 2.1 points, 95%CI 1.4 to 2.9, p < 0.01). There were no significant differences between the average grades on the oral exam and the multiple-choice exam (p = 0.37). Conclusion: medical students have worse grades on written exams in Pharmacology, as compared to oral and multiple-choice exams. This could possibly be associated with the fact that this type of exam is less frequently applied in Medical School. (AU)

Components of the item selection algorithm in computerized adaptive testing / 보건의료교육평가

Computerized adaptive testing (CAT) greatly improves measurement efficiency in high-stakes testing operations through the selection and administration of test items with the difficulty level that is most relevant to each individual test taker. This paper explains the 3 components of a conventional CAT item selection algorithm: test content balancing, the item selection criterion, and item exposure control. Several noteworthy methodologies underlie each component. The test script method and constrained CAT method are used for test content balancing. Item selection criteria include the maximized Fisher information criterion, the b-matching method, the a-stratification method, the weighted likelihood information criterion, the efficiency balanced information criterion, and the Kullback-Leibler information criterion. The randomesque method, the Sympson-Hetter method, the unconditional and conditional multinomial methods, and the fade-away method are used for item exposure control. Several holistic approaches to CAT use automated test assembly methods, such as the shadow test approach and the weighted deviation model. Item usage and exposure count vary depending on the item selection criterion and exposure control method. Finally, other important factors to consider when determining an appropriate CAT design are the computer resources requirement, the size of item pools, and the test length. The logic of CAT is now being adopted in the field of adaptive learning, which integrates the learning aspect and the (formative) assessment aspect of education into a continuous, individualized learning experience. Therefore, the algorithms and technologies described in this review may be able to help medical health educators and high-stakes test developers to adopt CAT more actively and efficiently.

CEACLIN, un instrumento en español para identificar estrategias para el aprendizaje de la clínica de estudiantes de medicina: Desarrollo y validación / CEACLIN, an instrument suited to identify medical students´ strategies to learn in pre-clerkship years

Background: Upon the beginning of pre-clerkship years, medical students must develop strategies to learn from experience and to improve their relational skills to communicate with patients. Aim: To develop an instrument to identify the strategies used by medical students to learn in clinical contexts. Material and Methods: Using a Delfi technique to reach consensus, a national panel of students and clinical teachers from 15 Chilean medical schools analyzed an 80-item questionnaire built from perceptions of Chilean students and teachers from one medical school. After two Delfi rounds and a pilot application, a 48-item questionnaire was obtained. Its reliability and construct validity were assessed by Cronbach alpha coefficient and factor analysis, respectively, on the base of an application to 336 medical students. Results: The questionnaire developed, named CEACLIN, is highly reliable (α= 0.84). Its inner structure is made of eleven factors: Autonomy, Solving doubts and problems, Searching and organizing information, Proactivity, Reaching to others, Paying attention and emotions, Searching for trust, Evading burden, Coping with burden, Motivation and Postponing the personal life. All together, these factors account for 47.4 % of the variance. Conclusions: CEACLIN is a valid, reliable and easy to use instrument suited to identify students´ strategies to learn in pre-clerkship years. Many of its items allude to concepts of theories of experiential learning and motivation. We hope that CEACLIN will be of value to medical students and clinical teachers to improve the learning and teaching of clinical reasoning and communication skills.

Effects of technical training in functional asymmetry of lower limbs in young soccer players / Efeitos do treino técnico na assimetria funcional dos membros inferiores de jovens futebolistas

Abstract The functional asymmetry of the lower limbs has been considered an important factor in the performance of soccer players. In this sense, the purpose of this study was to examine the effects of specific technical training for non-preferred foot on its utilization rate during the game; and to investigate if interruption of a technical training programme for the non-preferred foot influences its utilization rate during the game. Fifty young soccer players were randomly divided into two groups: G1 (n=26, 9.50±1.04 years) and G2 (n=24, 9.58±1.02 years). At the beginning of the first 4 months, each player's use of both feet during the game was assessed. The study lasted eight months divided into two periods of four months. In the first training period G1 was subjected to a technical training programme directed to the non-preferred foot, while G2 had no constraints on the use of both feet. At the end of the 4th month the two groups were newly assessed. During the second training period G1 and G2 reversed the training programmes. After the 8 months of training the evaluation of the utilization rate of both feet during small-side games was again performed. The main conclusions of the study were: (i) the technical training of the non-preferred foot allowed significant increases in its utilization rate during small-sided games; (ii) the interruption of such training partially reversed this effect. Thus, technical training for the non-preferred foot should be systematically performed in order to maintain the positive effects induced over functional asymmetry.

Resumo A assimetria funcional dos membros inferiores é considerada um fator relevante para o desempenho dos futebolistas. O presente estudo teve como propósitos: verificar se um programa de treinamento técnico para o pé não-preferido promovia o aumento do seu índice de utilização durante o jogo; e indagar se a interrupção do programa de treinamento técnico seria acompanhada pela inversão desse efeito. Cinquenta jovens futebolistas foram divididos aleatoriamente em dois grupos: G1 (n=26; 9,50±1,04 anos) e G2 (n=24; 9,58±1,02 anos). Antes do início do programa de treinamento avaliou-se em jogos reduzidos o índice de utilização de ambos os pés de cada jogador. O programa de treinamento teve a duração de 8 meses, divididos em dois períodos de 4 meses. Durante o primeiro período submeteu-se o G1 a um protocolo de treinamento do pé não preferido, enquanto que o G2 serviu de grupo controlo. Durante o segundo período de 4 meses o G1 interrompeu o treinamento técnico enquanto o G2 passou a realizar treinamento técnico. Terminados os 8 meses do programa de treinamento os dois grupos foram sujeitos a nova avaliação do índice de utilização dos membros inferiores. Concluiu-se que (i) o treinamento técnico direcionado para o pé não preferido permitiu aumentar significativamente o respetivo índice de utilização durante jogos reduzidos e que (ii) a interrupção do treinamento revertia de forma parcial este efeito. Deste modo, o treinamento técnico do pé não preferido de jovens futebolistas deverá ser sistemático de forma a que os efeitos positivos sobre a assimetria funcional possam ser mantidos.

Two-and-a-half year follow-up study of strategy factors in successful learning to predict academic achievements in medical education / 한국의학교육

PURPOSE: We performed a two-and-a-half year follow-up study of strategy factors in successful learning to predict academic achievements in medical education. METHODS: Strategy factors in successful learning were identified using a content analysis of open-ended responses from 30 medical students who were ranked in the top 10 of their class. Core words were selected among their responses in each category and the frequency of the words were counted. Then, a factors survey was conducted among year 2 students, before the second semester. Finally, we performed an analysis to assess the association between the factors score and academic achievement for the same students 2.5 years later. RESULTS: The core words were "planning and execution," "daily reviews" in the study schedule category; "focusing in class" and "taking notes" among class-related category; and "lecture notes," "previous exams or papers," and "textbooks" in the primary self-learning resources category. There were associations between the factors scores for study planning and execution, focusing in class, and taking notes and academic achievement, representing the second year second semester credit score, third year written exam scores and fourth year written and skill exam scores. Study planning was only one independent variable to predict fourth year summative written exam scores. CONCLUSION: In a two-and-a-half year follow-up study, associations were founded between academic achievement and the factors scores for study planning and execution, focusing in class, and taking notes. Study planning as only one independent variable is useful for predicting fourth year summative written exam score.

Exploration of examinees' traits that affect the score of Korean Medical Licensing Examination / 보건의료교육평가

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.

Confiabilidade de um teste funcional de desempenho do membro superior: Teste Elui / Reliability of the ELUI Upper Extremity Functionality Test

A destreza manual é uma habilidade fundamental para o desempenho das atividades cotidianas. Medidas da força muscular, amplitude de movimento e sensibilidade isoladamente podem não refletir o status funcional na avaliação físico-funcional. É importante também o uso de questionários autoaplicáveis e testes funcionais específicos que avaliem o desempenho levando em consideração o membro superior e que possam testar aspectos como a destreza, coordenação e qualidade da preensão, podendo variar em termos de padronização e propriedades psicométricas. A partir desta necessidade foi desenvolvido o Teste Funcional de Membro Superior Elui que visou oferecer um instrumento nacional de mensuração e de referência a ser utilizado na prática clínica, porém suas propriedades psicométricas ainda não são definidas. Objetivo: Analisar a confiabilidade interexaminador e teste re-teste do Teste Funcional de Membro Superior Elui. Método: 50 voluntários saudáveis, de ambos os sexos, com idade média de 32,62 anos que não apresentassem disfunção ou sintomatologia nos membros superiores foram submetidos ao teste por dois examinadores e após 30 dias por um examinador. A aplicação deste teste requer materiais simples presentes no cotidiano, divididos em 10 subitens: Simular Escrita, Virar Chave, Pegar pequenos objetos, Simular alimentação, Despejar água, Abrir Potes, Cortar com a Faca, Simular Vestuário, Pegar objetos Grandes e leves e Pegar objetos grandes e pesados. Cada voluntário avaliado deveria realizar cada item do teste com ambas as mãos ou com a mão dominante, dependendo do subitem analisado, sendo adaptada a lateralidade quando necessário. Resultados: A análise estatística foi realizada visando comparar as diferenças das medidas de cada sub-item do teste em segundos e a análise da confiabilidade interexaminadores e teste reteste pelo Coeficiente de Correlação Intraclasse (ICC) com intervalo de confiança de 95% e p < 0,05. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa local e todos os voluntários assinaram o termo de consentimento livre e esclarecido. Os resultados mostraram que com exceção da tarefa pegar pequenos objetos que teve ICC considerado não aceitável (0,65), todos os outros 9 itens apresentaram excelente confiabilidade interexaminadores entre 0,95-0,99 e Alpha de Cronbach entre 0,97-0,99. Para o teste reteste as tarefas com excelente confiabilidade foram despejar água ICC 0,98 e simular escrita ICC 0,91, boa confiabilidade para as tarefas pegar objetos grandes e pesados ICC 0,85, cortar com faca ICC 0,85 e simular alimentação ICC 0,80; confiabilidade aceitável dos itens virar chave ICC 0,74 e simular vestuário ICC 0,76; com Alpha de Cronbach de todas as tarefas entre 0,79 e 0,99. Conclusão: O Teste Elui apresentou excelente repetitividade tanto entre examinadores como em medidas repetidas ao longo do tempo pelo mesmo examinador na maioria dos subitens, sendo considerado confiável para a amostra estudada, sendo utilizada a terceira medida.

Manual dexterity is a key skill for the performance of everyday activities. Measurements of muscle strength, range of motion, and sensitivity alone may not reflect the functional status in assessing physical and functional conditions. It is also important to use self-applied assessments and specific functional tests to assess overall performance and test aspects such as dexterity, coordination and grasp quality, but these may differ in terms of standardization and psychometric properties. From this need we have developed the Elui Upper Extremity Functionality Test, with the intent to provide a national measuring instrument of the upper extremity and reference to be used in clinical practice, but its psychometric properties have not been yet defined. Objective: The aim of this study was to assess the inter-examiner reliability and test retest of the Elui Upper Extremity Functionality Test. Methods: Healthy volunteers (50) of both genders, with an average age of 32.62 years and no impairment or symptoms in the upper limbs were submitted to the test by two examiners and after 30 days by one examiner. The application of this test requires simple materials present in our everyday life, divided into 10 sub-items: Simulated writing, Turning a Key, Grasping small objects, Simulated feeding, Pouring water, Opening containers, Cutting with a knife, Simulated dressing, Grasping large and light objects, and Grasping large and heavy objects. Each volunteer evaluated should perform each item test with both hands or with the dominant hand, depending on the sub-item analyzed, and if needed, they adapted the laterality. Results: A statistical analysis was carried out to compare the differences in time measurements of each sub-item of the test in seconds. The analysis of the inter-examiner reliability and test-retest used the Interclass Correlation Coefficient (ICC) with a confidence interval of 95% and p < 0.05. The local Research Ethics Committee approved this study and all volunteers signed an informed consent form. With the exception of the Grasping small objects task, which had an unacceptable ICC (0.65), the results showed that all the other nine items had excellent inter-examiner reliability: between 0.95 and 0.99 and Cronbach's alpha between 0.97 and 0.99. For the test-retest, the tasks with excellent reliability were Pouring water ICC 0.98 and simulated writing with ICC 0.91, good reliability for the tasks Grasping large and heavy objects ICC 0.85, Cutting with a knife ICC 0.85 and Simulated feeding ICC 0.80; acceptable reliability for the items Turning a key ICC 0.74 and Simulated dressing ICC 0.76; with Cronbach's alpha of all tasks between 0.79 and 0.99. Conclusion: The Elui test showed excellent repeatability between examiners as well as with repeated measurements over time by the same examiner in most sub-items, being considered reliable for the studied sample using the third measurement.

The performance of students with and without disability on the 11th grade university admission test / Rendimiento en la prueba de admisión a la universidad (Saber 11) de personas en y sin condición de discapacidad

Objective Comparing standardized university admission scores between students with and without disability within the same school and also comparing the performance of students with hearing, visual and physical disability. Methods This was a retrospective cohort study which compared the test results of students with and without disabilities within the same school. A matched case-control study nested in a cohort was assembled. Standardized differences were calculated for comparing such scores. Results Students without disabilities performed significantly better than disabled ones(i.e. disabled students scored lower than their classmates). Conclusion Further research is needed to determine whether the Colombian educational system, adjustments made to tests for this population or students' individual skills were the factors underlying the difference regarding the test results.

Objetivo Comparar los resultados en la prueba Saber 11 (prueba estandarizada para la admisión en la mayoría de universidades de Colombia) entre los estudiantes con y sin discapacidad dentro de la misma institución educativa. Asimismo, comparar el rendimiento de los alumnos con problemas de audición, discapacidad visual y física. Métodos Se realizó un estudio de cohorte retrospectiva en la que se dividió a los estudiantes según su condición de discapacidad. Se anidó un caso-cohorte emparejando cada caso de discapacidad con su grupo de compañeros de colegio. Se calcularon las diferencias estandarizadas para comparar los grupos. Resultados Los estudiantes sin discapacidades se desempeñaron significativamente mejor que los estudiantes con discapacidad, es decir, los estudiantes con discapacidades obtuvieron puntajes más bajos que sus compañeros de clase. Conclusión Se necesita más investigación para investigar si el sistema educativo colombiano, los ajustes en las pruebas para esta población o las capacidades individuales de los alumnos son los factores subyacentes de la diferencia en los resultados de las pruebas.

Strategies for Effective Teaching in Clinical Clerkship / 한양의대학술지

Clerkship has a vital role in undergraduated medical education. Despite potential benefits, clinical teaching has been much criticised for its variability due to its complex clinical environment. This article describes several problems and educational theories related to learning in clinical settings. Effective strategies were developed after these problems arised and learning theories were created, in terms of students, clinical teachers and teaching institution: first, the student should prepare medical knowledge and survival skills for self-directed learning in the clinical setting; second, the clinical teachers provide opportunities for active participation-effective feedback-reflection to students; and lastly, the teaching institution has to design a clerkship curriculum effectively. A clinical environment for students allowing them to participate actively is essential.