Medical professionalism among emergency physicians in South Korea: a survey of perceptions and experiences of unprofessional behavior

Objective@#The purpose of this study was to analyze the current situation concerning professionalism among emergency physicians in South Korea by conducting a survey regarding their perceptions and experiences of unprofessional behavior. @*Methods@#In October 2018, the authors evaluated the responses to a questionnaire administered to 548 emergency physicians at 28 university hospitals. The participants described their perceptions and experiences concerning 45 unprofessional behaviors classified into the following five categories: patient care, communication with colleagues, professionalism at work, research, and violent behavior and abusive language. Furthermore, the responses were analyzed by position (resident vs. faculty). Descriptive statistics were generated on the general characteristics of the study participants. To compare differences in responses by position and sex, the chi-square and Fisher exact tests were performed. @*Results@#Of the 548 individuals invited to participate in this study, 253 responded (response rate, 46.2%). In 34 out of 45 questionnaires, more than half of participants reported having experienced unprofessional behavior despite their negative perceptions. Eleven perception questions and 38 experience questions for unprofessional behavior showed differences by position. @*Conclusion@#Most emergency physicians were well aware of what constituted unprofessional behavior; nevertheless, many had engaged in or observed such behavior.

Development of guide to clinical performance and basic clinical skills for medical students / 한국의학교육

The aim of this report was to discuss the development and content of a guide on clinical performance and basic clinical skills for medical students. We published the first edition of this guide in 2010 and will publish the second edition in 2016. Initially, we took a survey on important clinical presentations and fundamental clinical and technical skills in 41 medical schools in Korea. Ultimately, we chose 80 core clinical presentations and 56 clinical skills. In the guide to basic clinical skills, we described the physical examination and technical skills according to the preprocedural preparation, procedure, and postprocedural process. In the guide on clinical performance, we reviewed patient encounters-from history taking and the physical examination to patient education. We included communication skills, principles of patient safety, and clinical reasoning schemes into the guides. In total, 43 academic faculty members helped develop the basic clinical skills guide, 75 participated in establishing the clinical performance guide, and 16 advisors from 14 medical specialty societies contributed to the guide. These guides can help medical students approach patients holistically and safely.

Analytical Case Study of Evaluation of Curriculum at a Medical School / 한국의학교육

PURPOSE: This study aims at to make intermediate-term evaluations of a curriculum by investigating its development, operation and outcomes 2 years after its revision. METHODS: A survey using 5-point-Lickert scale questionnaires was given to the group of directors who developed the curriculum, instructors who only used it in their classes, and a student group from the first and second grades. Focus group interviews were performed in the professor groups. RESULTS: Curricular reform was evaluated as being systematic, democratic, and positive in general. Both groups answered questions positively about the relevance of the integrated curriculum and introduction of clinical medicine (ICM), graded as 3.4 (professor) and 3.5 (student). As for problem-based learning (PBL) and the patient-doctor-society (PDS), the professor group responded more positively than students. The 'web-based learning center' was recognized positively by many more students (4.01) than professors (2.75). With regard to the education outcome, professors gave 3.3 points and students 3.5 to an item that asked 'whether students attained the learning goal or not?' Professors, through interviews, showed their satisfaction with the attempt to reform the curriculum, but they pointed out that long-term evaluations should be performed. CONCLUSION: The interim evaluation of the revised curriculum, from its planning to its effects, affirmed by several suggestions to be successful in the long run through 1) enhancement of systematic participation and communication, 2) further integration, 3) steady evaluation, 4) greater effort on professional development, and 5) active interaction between professors and students.

The Comparison of Clinical Performance Examination Scores according to the Different Testing Time: Six Medical Schools in Seoul.Gyeonggi CPX Consortium 2005 / 한국의학교육

PURPOSE: Clinical performance examination(CPX) using standardized patients(SPs) is an acceptable method of testing medical professionals, but there has been some concerns about security. The objective of this work is to examine whether the day of the examination influences the scores of examinees of different medical schools at different times throughout the examination period. METHODS: Six medical schools, which had participated in the Seoul-Gyeonggi CPX Consortium 2005, were enrolled. Each station, controlled by the same regulations, included 12 minutes of SP encounter and 5 minutes of writing a short essay. We compared the mean scores using ANOVA and linear trends with multiple regression analyses and SPSS version 11.0. RESULTS: The mean score of examinees from all 6 medical schools was 63.2+/-.9. There was no difference in total mean scores among the medical schools according to the period when CPX was conducted. Classified by their examination day, there was no difference among the mean scores of the 1st, 2nd, and 3rd day, but in one school where the examination was performed for 5days, the mean scores of the 4th day was higher than the others(p<0.05). There were trends of linear increases over the five days for the 'physical examination'question, but not for 'physician-patient interaction'and 'patient education'. CONCLUSION: The changes in scores according to the examination day in this study did not show consistent results. However, the variable results seen according to school, test question, and examination day need further analysis for test security issues.

Comparison of the Evaluation Results of Faculty with Those of Standardized Patients in a Clinical Performance Examination Experience / 한국의학교육

PURPOSE: To compare the evaluation results of faculties to those of Standardized Patients (SP) participating in a Clinical Performance Examination (CPX) administered at Ewha Womans University College of Medicine. METHODS: The CPX was taken by 77 fourth year medical students. Cases and checklist were developed by the medical school consortium in capital area. Six cases were used and 24 SPs participated and evaluated the students' performances. The whole session was recorded on videotapes so that 6 medical school faculties could analyze and evaluate the students' performances as well. The results were compared and analyzed by SPSS package. RESULTS: The agreement between the faculties and the SPs was relatively good (r=0.79), but not good enough. In every case, SPs gave higher marks than did the faculties. Clear disease entity cases like "hepatitis" and "anemia" showed better agreement than obscure clinical contexts such as "bad news delivery". Better agreement was seen in the items of physical exam category (r=0.91), but the agreement was very poor in the items of doctor-patient (Dr-Pt) relationship category (r=0.54). The construction of checklist and the character of each evaluation item should influence the differences. CONCLUSION: More detailed guidelines and clear/specific evaluating items are necessary to improve the agreement rate. In certain categories like physical exam and brief history taking, the SP' s evaluation can replace the faculties', but for complex contexts like Dr-Pt relationship.

An OSCE for Summative Assessment after Clinical Clerkship: Experience in Ewha Medical School / 한국의학교육

PURPOSE: To report the experience of OSCE performed as a summative assessment of the medical students in year 4 at Ewha Womans University. METHODS: Ninety-eight students took the twenty stations including 3 pairs of linked stations. We conducted duplicated OSCEs and each station runs 4 minutes 30 seconds. We analyzed the validity of stations, the reliability of duplicated OSCEs and the difference of scores according to the OSCE tools and categories. RESULTS: Mean OSCE score was 64.45+/-5.49 and Cronbach-alpha of total stations was 0.74. The scores between duplicated examinee groups and between duplicated evaluator groups were not different: the score of preceding examinee group was 63.3 and the later 65.7 (p=0.13), and the score of the first evaluator group was 64.6 and the second was 63.6 (p=0.16). However according to the individual analysis, 9 stations showed statistically discrepancies (p< 0.05) between duplicated evaluator groups. Regarding OSCE tools and categories, physical examination and skill categories did not show statistically significant differences between duplicated evaluator groups. OSCE scores showed moderate correlation with the cummulative performance grade in general (r=0.53, p< 0.01). CONCLUSIONs: OSCE could be regarded as a reasonable evaluating tool for the summative assessment after two years of clinical clerkship of the fourth year medical students. Analysis of the OSCE stations which was done individually and according to OSCE tools/categories helps to improve the OSCE more complete and the duplicated stations more coincident.