The Relationship Between Social Presence and Learning Satisfaction in Videoconferencing Problem‐Based Learning / 의학교육논단

Despite current regulations requiring social distancing due to coronavirus disease 2019, problem-based learning (PBL) requires student interaction to achieve common goals and enhance critical thinking and deep learning abilities. Social presence in the online education environment reduces both perceptions of physical distance and psychological distance in interactions. This study aimed to compare PBL activities between in-person and videoconferencing classes, and to investigate social presence and learning satisfaction in a videoconferencing PBL environment. The PBL consisted of six modules for both the first and second years of Chonnam National University Medical School. As social distancing was strengthened, the second class of the fifth module in both years was converted to an online format and the fifth module was excluded. The first four PBL modules were conducted as in-person classes, but the last PBL module was administered via videoconferencing. After the final PBL module, 100 (81.3%) first-year medical students and 90 (79.6%) second-year students were asked to complete a self-administered questionnaire on social presence and learning satisfaction. There were no significant differences in the small group activities of tutorial sessions between in-person and videoconferencing classes. In the online videoconferencing class, students who had favorable attitudes toward the tutors’ social role and interactions with peers showed high satisfaction with their learning. In conclusion, online videoconferencing allows students to simultaneously perceive their interactions with others and social presence, even at a distance. Tutors can enhance a sense of online community and collaborative learning as facilitators of online PBL.

Weight Gain and Lipid Profile Changes in Koreans with Human Immunodeficiency Virus undergoing Integrase Strand Transfer Inhibitor-Based Regimens / 감염과화학요법

Background@#This study explored the relationship between integrase strand transfer inhibitor (INSTI)-based anti-retroviral agents and weight gain over time, and the risk factors for weight gain in Korean people living with human immunodeficiency virus (PLWH). @*Materials and Methods@#The study was conducted retrospectively in PLWHs 18 years of age or older who took one of three INSTI-based single-tablet regimens (STRs) (tenofovir disoproxil fumarate/emtricitabine/elvitegravir/cobicistat [TDF/F/EVG/c], tenofovir alafenamide/ emtricitabine/elvitegravir/cobicistat [TAF/F/EVG/c], and abacavir/lamivudine/dolutegravir [ABC/3TC/DTG]) for more than 2 years at three university-affiliated hospitals in South Korea from May 2014 to December 2020. Analysis was performed in the treatment-naïve and treatment-experienced groups, respectively. @*Results@#Individual INSTI-based STRs were associated with weight gain at the 24-month follow up in both treatment-naïve (n = 179) and treatment-experienced (n = 290) groups.Body mass index (BMI) categories changed over time for TAF/F/EVG/c and ABC/3TC/ DTG, with significant increases in the rates of overweight and obesity in treatment-naïve patients, whereas there was no change for TDF/F/EVG/c. TAF/F/EVG/c significantly increased total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) compared to other regimens over 24 months. In the treatment-naïve group, a baseline CD4+ T cell count <100 cells/mm3 , human immunodeficiency virus (HIV) viral load (VL) ≥100,000 copies/mL, no physical exercise, and TAF/F/EVG/c (vs. TDF/F/EVF/c) were risk factors for ≥10% weight gain. In the treatment-experienced group, age <45 years, BMI <25 kg/m2 , and no physical exercise were risk factors for ≥5% weight gain. @*Conclusion@#INSTI-based STR continued to increase body weight at the 24-month follow up in treated and untreated Korean PLWH. Exercise, together with demographic-, HIV-, and anti-retroviral therapy-related factors, influenced weight gain. Therefore, when prescribing an INSTI-based STR, weight gain and metabolic changes should be closely monitored in PLWH with these risk factors.

Latent Profile Analysis of Medical Students’ Use of Motivational Regulation Strategies for Online Learning / 의학교육논단

Due to the coronavirus disease 2019 pandemic, the new norm of online learning has been recognized as core to medical institutions for academic continuity, and students are expected to be motivated and engaged in learning while maintaining distance from other peers and educators. To facilitate students’ and educators’ newly defined roles in online medical education settings, it is crucial to understand how students are actively motivated and engaged in learning. Hence, this study explored medical students’ motivational regulation profiles and examined the effects of motivational regulation strategies (MRS) on cognitive learning and learning engagement for online learning. Data were collected after the end of the first semester in 2020 from a sample of 334 medical students enrolled at a public university school of medicine. Latent profile analysis indicated three subgroups with different motivational regulation profiles: the low-profile, medium-profile, and high-profile groups. Regarding different MRS patterns in the high-profile group, mastery self-talk, performance approach self-talk, and the self-consequating strategy appeared to be most applicable for regulating learners’ motivation. Analysis of variance showed that the profile groups with higher levels of MRS use were connected to a higher willingness to use cognitive learning strategies and a higher degree of engagement in online learning. The findings of this study emphasize the use of specific sets of MRS to support learning motivation and the need to design effective self-regulated learning environments in online medical education settings.

Exploring the structural relationships between medical students’ motivational regulation, cognitive learning, and academic performance in online learning / 한국의학교육

Purpose@#The purpose of this study was to investigate the effect of motivational regulation strategies (MRSs) on cognitive learning and academic performance. @*Methods@#The participants were a total of 510 pre-medical and medical students. Survey instruments assessed the use of MRSs and cognitive learning strategies. Students’ grade point averages were used for academic performance. Structural equation modeling was used to analyze data, using Mplus ver. 7.4 (Muthén & Muthén, Los Angeles, USA). @*Results@#Confirming the measurement model validity, the results of structural model indicated the followings: (1) MRSs had a significant impact on cognitive learning, while these strategies negatively affected academic performance; (2) cognitive learning significantly influenced academic performance and mediated the effect of MRSs on academic performance; and (3) only academic levels had a significant effect on cognitive learning. @*Conclusion@#The findings from this study confirmed that MRSs were highly influential to predicting students’ cognitive learning which affects their better learning performance. Thus, instructional design and practice to support learning motivation is needed to promote cognitive learning and training programs to practice the effective methods of using MRSs in learning need to be provided.

Latent Profile Analysis of Medical Students’ Use of Motivational Regulation Strategies for Online Learning / 의학교육논단

Due to the coronavirus disease 2019 pandemic, the new norm of online learning has been recognized as core to medical institutions for academic continuity, and students are expected to be motivated and engaged in learning while maintaining distance from other peers and educators. To facilitate students’ and educators’ newly defined roles in online medical education settings, it is crucial to understand how students are actively motivated and engaged in learning. Hence, this study explored medical students’ motivational regulation profiles and examined the effects of motivational regulation strategies (MRS) on cognitive learning and learning engagement for online learning. Data were collected after the end of the first semester in 2020 from a sample of 334 medical students enrolled at a public university school of medicine. Latent profile analysis indicated three subgroups with different motivational regulation profiles: the low-profile, medium-profile, and high-profile groups. Regarding different MRS patterns in the high-profile group, mastery self-talk, performance approach self-talk, and the self-consequating strategy appeared to be most applicable for regulating learners’ motivation. Analysis of variance showed that the profile groups with higher levels of MRS use were connected to a higher willingness to use cognitive learning strategies and a higher degree of engagement in online learning. The findings of this study emphasize the use of specific sets of MRS to support learning motivation and the need to design effective self-regulated learning environments in online medical education settings.

Exploring the structural relationships between medical students’ motivational regulation, cognitive learning, and academic performance in online learning / 한국의학교육

Purpose@#The purpose of this study was to investigate the effect of motivational regulation strategies (MRSs) on cognitive learning and academic performance. @*Methods@#The participants were a total of 510 pre-medical and medical students. Survey instruments assessed the use of MRSs and cognitive learning strategies. Students’ grade point averages were used for academic performance. Structural equation modeling was used to analyze data, using Mplus ver. 7.4 (Muthén & Muthén, Los Angeles, USA). @*Results@#Confirming the measurement model validity, the results of structural model indicated the followings: (1) MRSs had a significant impact on cognitive learning, while these strategies negatively affected academic performance; (2) cognitive learning significantly influenced academic performance and mediated the effect of MRSs on academic performance; and (3) only academic levels had a significant effect on cognitive learning. @*Conclusion@#The findings from this study confirmed that MRSs were highly influential to predicting students’ cognitive learning which affects their better learning performance. Thus, instructional design and practice to support learning motivation is needed to promote cognitive learning and training programs to practice the effective methods of using MRSs in learning need to be provided.

The perception of medical residents and faculty members on resident duty hour regulation / 한국의학교육

Purpose@#This study investigated the perceptions of medical residents and faculty members before the implementation of the duty hour regulation in December 2017. @*Methods@#A survey was administered to 263 residents and 358 faculty members in the Chonnam National University Hospital. The subjects were given a self-administered structured questionnaire designed to measure their perspectives on duty hour regulation. They were also asked to answer an open-ended question regarding their expectations or concerns regarding duty hour regulation. The response rates were 50.2% for residents and 24.0% for faculty members. @*Results@#Residents and faculty members regarded the improvement of junior residents’ well-being favorably, but had conflicting views regarding senior residents. Residents expressed difficulty in completing unchanged workloads within the limited time, while faculty members were more concerned about worsening patient safety due to the discontinuity of care and insufficient resident education. @*Conclusion@#Medical residents and faculty members had differing concerns regarding duty hour regulation. Further studies and the development of future policies should be considered to improve resident education and patient safety within the limited duty hour regulation.

The Relationship between Medical Students' Assessment of Standardized Patients and Patient-Physician Interaction Score / 의학교육논단

When standardized patients (SPs) are used for educational purposes, the authenticity of role play and the quality of feedback are essential requirements of SPs. This study was conducted to investigate medical students' assessment of SPs and to identify the components of SPs' performance that were most strongly correlated with patient-physician interaction score. One hundred and forty-two fourth-year medical students were asked to complete the Maastricht Assessment of Simulated Patients (MaSP) at the end of a clinical performance examination. SPs evaluated the patient-physician interactions using a 4-point Likert scale (1=poor to 4=excellent). Medical students' assessment of SPs using the MaSP was positively correlated with patient-physician interactions (r=0.325, p<0.01). Items addressing the authenticity of role play (e.g., “SPs appear authentic,”“SPs might be real patients,” and “SPs answer questions in a natural manner”) were closely correlated with patient-physician interactions (p<0.001, p=0.027, and p=0.017, respectively). These results showed that the MaSP appears to be a useful instrument for evaluating SPs' performance and that the authenticity of SPs' performance was positively correlated with medical students' interactions. In order to improve patient-physician interactions, medical students should be given opportunities to practice their skills with SPs who have been trained to portray patients with a specific condition in a realistic way.

Korean medical students' attitudes toward academic misconduct: a cross-sectional multicenter study / 한국의학교육

PURPOSE@#This study investigated medical students' attitudes toward academic misconduct that occurs in the learning environment during the pre-clinical and clinical periods.@*METHODS@#Third-year medical students from seven medical schools were invited to participate in this study. A total of 337 of the 557 (60.5%) students completed an inventory assessing their attitudes toward academic misconduct. The inventory covered seven factors: scientific misconduct (eight items), irresponsibility in class (six items), disrespectful behavior in patient care (five items), dishonesty in clerkship tasks (four items), free riding on group assignments (four items), irresponsibility during clerkship (two items), and cheating on examinations (one item).@*RESULTS@#Medical students showed a strict attitude toward academic misconduct such as cheating on examinations and disrespectful behavior in patient care, but they showed a less rigorous attitude toward dishonesty in clerkship tasks and irresponsibility in class. There was no difference in students' attitudes toward unprofessional behaviors by gender. The graduate medical school students showed a stricter attitude toward some factors of academic misconduct than the medical college students. This difference was significant for irresponsibility in class, disrespectful behavior in patient care, and free riding on group assignments.@*CONCLUSION@#This study indicates a critical vulnerability in medical students' professionalism toward academic integrity and responsibility. Further study evidence is needed to confirm whether this professionalism lapse is confined only to this population or is pervasive in other medical schools as well.

Korean medical students' attitudes toward academic misconduct: a cross-sectional multicenter study / 한국의학교육

PURPOSE: This study investigated medical students' attitudes toward academic misconduct that occurs in the learning environment during the pre-clinical and clinical periods. METHODS: Third-year medical students from seven medical schools were invited to participate in this study. A total of 337 of the 557 (60.5%) students completed an inventory assessing their attitudes toward academic misconduct. The inventory covered seven factors: scientific misconduct (eight items), irresponsibility in class (six items), disrespectful behavior in patient care (five items), dishonesty in clerkship tasks (four items), free riding on group assignments (four items), irresponsibility during clerkship (two items), and cheating on examinations (one item). RESULTS: Medical students showed a strict attitude toward academic misconduct such as cheating on examinations and disrespectful behavior in patient care, but they showed a less rigorous attitude toward dishonesty in clerkship tasks and irresponsibility in class. There was no difference in students' attitudes toward unprofessional behaviors by gender. The graduate medical school students showed a stricter attitude toward some factors of academic misconduct than the medical college students. This difference was significant for irresponsibility in class, disrespectful behavior in patient care, and free riding on group assignments. CONCLUSION: This study indicates a critical vulnerability in medical students' professionalism toward academic integrity and responsibility. Further study evidence is needed to confirm whether this professionalism lapse is confined only to this population or is pervasive in other medical schools as well.

Premedical Curriculum at Chonnam National University Medical School / 의학교육논단

The educational goal of premedical education is to provide the desired college-level training in liberal arts as well as sciences, and to equip students with a basis for future medical studies. The purpose of this study was to introduce a premedical curriculum at Chonnam National University Medical School and to provide baseline data for developing an improved premedical curriculum. The reformed premedical curriculum has been followed since 2017. Formal premedical curriculum consists of basic education and character education through liberal arts study and major courses related to medical education. In addition to the formal premedical curriculum, students are supported through various programs that help develop interpersonal and intrapersonal competences.

The relationship between medical students' epistemological beliefs and achievement on a clinical performance examination / 한국의학교육

PURPOSE: This study was to explore the relationship between clinical performance examination (CPX) achievement and epistemological beliefs to investigate the potentials of epistemological beliefs in ill-structured medical problem solving tasks. METHODS: We administered the epistemological beliefs questionnaire (EBQ) to fourth-year medical students and correlated the results with their CPX scores. The EBQ comprised 61 items reflecting five belief systems: certainty of knowledge, source of knowledge, rigidity of learning, ability to learn, and speed of knowledge acquisition. The CPX included scores for history taking, physical examination, and patient-physician interaction. RESULTS: The higher epistemological beliefs group obtained significantly higher scores on the CPX with regard to history taking and patient-physician interaction. The epistemological beliefs scores on certainty of knowledge and source of knowledge were significantly positively correlated with patient-physician interaction. The epistemological beliefs scores for ability to learn were significantly positively correlated with those for history taking, physical examination, and patient-physician interaction. CONCLUSION: Students with more sophisticated and advanced epistemological beliefs stances used more comprehensive and varied approaches in the patient-physician interaction. Therefore, educational efforts that encourage discussions pertaining to epistemological views should be considered to improve clinical reasoning and problem-solving competence in the clinic setting.

Does medical students' clinical performance affect their actual performance during medical internship?

<p><b>INTRODUCTION</b>This study examines the relationship between the clinical performance of medical students and their performance as doctors during their internships.</p><p><b>METHODS</b>This retrospective study involved 63 applicants to a residency programme conducted at the Chonnam National University Hospital, South Korea, in November 2012. We compared the performance of the applicants during their internship with the clinical performance of the applicants during their fourth year of medical school. The performance of the applicants as interns was periodically evaluated by the faculty of each department, while the clinical performance of the applicants as fourth year medical students was assessed using the Clinical Performance Examination (CPX) and the Objective Structured Clinical Examination (OSCE).</p><p><b>RESULTS</b>The performance of the applicants as interns was positively correlated with their clinical performance as fourth year medical students, as measured by CPX and OSCE. The performance of the applicants as interns was moderately correlated with the patient-physician interactions items addressing communication and interpersonal skills in the CPX.</p><p><b>CONCLUSION</b>The clinical performance of medical students during their fourth year in medical school was related to their performance as medical interns. Medical students should be trained to develop good clinical skills, through actual encounters with patients or simulated encounters using manikins, so that they are able to become competent doctors.</p>

The relationship between problem-based learning and clinical performance evaluations / 한국의학교육

PURPOSE: To explore the relationship between problem-based learning (PBL) evaluations and clinical performance. METHODS: The study included 117 third-year medical students at Chonnam National University Medical School. The students' first-, second-, and third-year PBL evaluations were compared with their clinical performance examination (CPX) scores in third year. The PBL evaluations were composed of three subscales: tutors' evaluation (students' professional behavior, contribution to group process, and contribution to group content), a report, and a written examination. The CPX assessed four performance categories: history taking, physical examination, information sharing, and patient-physician interaction. RESULTS: No significant correlation was found between the first-year PBL evaluations and CPX scores; however, the second-year PBL evaluations were significantly correlated with history taking (r=0.186, p=0.044) and patient-physician interaction (r=0.213, p=0.021) of CPX. The third-year PBL evaluations were significantly correlated with physical examination (r=0.248, p=0.007), and patient-physician interaction (r=0.283, p=0.002) of CPX. Several significant correlations between the PBL evaluations subscales and CPX scores were revealed. The PBL tutors' evaluation (r=0.343, p=0.000) and report scores (r=0.210, p=0.023) were significantly correlated with patient-physician interaction of CPX. The contribution to group process of tutors' evaluation was significantly correlated with patient-physician interaction (r=0.186, p=0.045), and the contribution to group content of tutors' evaluation was significantly correlated with physical examination (r=0.187, p=0.044). CONCLUSION: We found a significant association between PBL evaluations and CPX scores.

Restoring force of medical school / 한국의학교육

No abstract available.

Mentoring experience and its effects on medical interns

<p><b>INTRODUCTION</b>Effective mentoring helps interns in the early stages of their medical career to reach personal and professional goals. This study investigated the mentoring experience of Korean interns during medical internship and evaluated mentoring effects to facilitate the development of future mentoring programmes.</p><p><b>METHODS</b>Participants were interns being trained at Chonnam National University Hospital, South Korea, in 2011. Interns were asked to complete a questionnaire about their mentoring experiences and job satisfaction.</p><p><b>RESULTS</b>A total of 61 medical interns participated in the study, giving a response rate of 70.1%. Among these interns, 26 (42.6%) had mentoring experiences, with an average of 2.3 ± 1.9 mentors per mentee. Mentees usually discussed career planning and concerns regarding their personal and social lives with their mentors. Perceived quality of the mentor was significantly more important for male mentees than for female mentees. Female interns without a mentor made significantly less effort to seek a mentor than their male counterparts. Having and not having a mentor resulted in significant differences in the interns' job satisfaction.</p><p><b>CONCLUSION</b>Fewer than half of the medical interns had mentoring experiences. Results suggest that the mentoring relationship may be less satisfying and more challenging for female interns. Effective mentoring may not only help interns plan their medical career, but also increase job satisfaction. Mentoring programmes during medical internship should be expanded and supported, as it is the initial step in a medical career.</p>

Impact of Physician's Education on Adherence to Tuberculosis Treatment for Patients of Low Socioeconomic Status in Bangladesh / 전남의대학술지

Successful tuberculosis control depends on good adherence to treatment. Yet, limited data are available on the efficacy of methods for improving the adherence of patients of low socioeconomic status. We evaluated the impact of physician-provided patient education on adherence to anti-tuberculosis medication in a low socioeconomic status and resource-limited setting. A pre-/post-intervention study was conducted at a suburban primary health care clinic in Bangladesh where an intensive education strategy was established in May 2006. Treatment outcomes of tuberculosis patients from March 2005 to April 2006 (pre-intervention) and from May 2006 to December 2007 (post-intervention) were compared. Among 354 patients, 198 (56%) were treated before intervention and 156 (44%) were treated after intervention. Cumulative adherence to anti-tuberculosis medication was significantly greater in the intervention group than in the control group in univariate and multivariate analyses. Physician's education can contribute to increasing the adherence of patients in resource-limited settings.

Evaluation of Cognitive Functions in Patients with Narcolepsy / 農村醫學 地域保健

OBJECTIVE: This study aimed to evaluate attention, memory and executive function in patients with narcolepsy. METHODS: This study included 23 narcoleptic patients whose diagnosis were confirmed by the International Classification of Sleep Disorders(ICSD) at Chonnam National University Hospital Sleep Disorders Clinic or an other hospital in Korea, from 2005 to 2008, as well as 23 normal controls. All participants were given an IQ test for Korean-Wechsler Adult Intelligence Scale and several neuropsychological function tests (the d2 test for attention function, the Rey Complex Figure Test for nonverbal memory, the Korean-California Verbal Learning Test [K-CVLT] for verbal memory, and the Wisconsin Card Sorting Test for executive function). Clinical features of narcoleptic patients, including the frequency of excessive daytime sleepiness, cataplexy, sleep paralysis and hypnagogic hallucination, were investigated by a structured clinical interview administered by a neuropsychiatist. Excessive daytime sleepiness was evaluated by the Epworth sleepiness scale. RESULTS: Characteristic symptoms of narcolepsy observed in this study included excessive daytime sleepiness (n=23, 100.0%), cataplexy (n=19, 82.6%), hypnagogic hallucination (n=5, 21.7%) and sleep paralysis (n=12, 52.2%). In nocturnal polysomnographic findings, stage 2 sleep and REM latency were found to be significantly decreased in narcoleptic patients compared with the control group, and were accompanied by significant increases in stage 1 sleep. Narcoleptic patients had lower scores than the control group on total number, Total Number-Total Error, Concentration Performance and Fluctuation Rate on the d2 test, which measures attention. Also, there were significant differences between the performance of patient and control groups on the B list of the K-CVLT, which measures verbal memory. CONCLUSION: Narcoleptic patients showed decreased attention and verbal memory performance compared to the control group; however, in many areas, narcoleptic patients still demonstrated normal cognitive function.

Impact of Physician's Education on Adherence to Tuberculosis Treatment for Patients of Low Socioeconomic Status in Bangladesh / 전남의대학술지

Successful tuberculosis control depends on good adherence to treatment. Yet, limited data are available on the efficacy of methods for improving the adherence of patients of low socioeconomic status. We evaluated the impact of physician-provided patient education on adherence to anti-tuberculosis medication in a low socioeconomic status and resource-limited setting. A pre-/post-intervention study was conducted at a suburban primary health care clinic in Bangladesh where an intensive education strategy was established in May 2006. Treatment outcomes of tuberculosis patients from March 2005 to April 2006 (pre-intervention) and from May 2006 to December 2007 (post-intervention) were compared. Among 354 patients, 198 (56%) were treated before intervention and 156 (44%) were treated after intervention. Cumulative adherence to anti-tuberculosis medication was significantly greater in the intervention group than in the control group in univariate and multivariate analyses. Physician's education can contribute to increasing the adherence of patients in resource-limited settings.

Medical Residents' Job Satisfaction and Their Related Factors / 한국의학교육

PURPOSE: This study was conducted to investigate medical residents' job satisfaction and their related factors to improve the quality of residency program. METHODS: The study subjects were 159 medical residents being trained at Chonnam National University Hospital, South Korea, in 2011. The participants were asked to complete a short form Minnesota satisfaction questionnaire (MSQ). RESULTS: The mean score for 20 items on the short form MSQ varied between 2.91 and 3.64 on a 5-point Likert scale. The assessment of related factors with job satisfaction revealed that medical residents had higher levels for job satisfaction, particularly those who were women (beta=0.200, p=0.022), and those who had mentorship experience (beta=0.219, p=0.008). CONCLUSION: This study results indicate that we should expand and support the mentorship program during medical residency to promote job satisfaction.