Medical Students' Goals, Methods and Opinions on Self-directed Learning and Analysis of Self-assessment / 한국의학교육

PURPOSE: The purpose of this study was to investigate the goals, methods and opinions of medical students on self-directed learning (SDL) and to compare the self-assessments with faculty-evaluations. METHODS: The study group included 90 medical students doing their clerkship in the department of Laboratory Medicine, Mokdong Hospital, Ewha Womans University, School of Medicine, Seoul, Korea, from August 2005 to October 2006. Students were asked to review cases, formulate learning goals, implement appropriate learning strategies and present learning outcomes. Students' opinions on SDL were collected. Their self-assessments were compared with the faculty evaluation scores using the same checklist. Three groups were defined according to the faculty scores: scores >12, high; scores 10~12, middle; scores <9, low. RESULTS: SDL was helpful in increasing confidence in students' own learning abilities and in raising interest in the patient-doctor relationship. Some students had difficulty formulating learning goals on their own. The mean of the self-assessments was significantly higher than that of faculty mean (11.8+/-2.1 vs. 10.9+/-2.3, p=.005). Rater agreement by items was approximately 30%. There was significant interaction between raters and group. Among the 'high' group, 55% under-rated their scores to middle or low levels, whereas 66% of the 'low' group rated themselves higher to high or middle levels. Spearman's correlation coefficient between faculty's and student's scores was r=.219 (p=.038) and 4.4% of the faculty evaluations was predicted by the self-assessment scores. CONCLUSION: These results suggest that SDL is an effective learning tool during clerkship. Since students' scores did not correlate with those of the faculty's, students need to develop appropriate self-assessment skills.

Comparison of Results from Objective Structured Clinical Examinations for Medical Students Performed Before and After Clinical Clerkship / 한국의학교육

PURPOSE: We conducted objective structured clinical examinations (OSCEs) in medical students both before entering clinical clerkship and after finishing clinical clerkship for the purpose of evaluating the usefulness of OSCEs before clinical clerkship. METHODS: The subjects of the study comprised 77 3rd-year medical students who participated in a 2-week course of physical diagnosis before clinical clerkship, and 98 4th-year medical students who had completed their clinical clerkship. The OSCE consisted of 17 cases and 17 stations for the 3rd-year medical students, and 20 cases and 28 stations for the 4th-year students. We assigned 4 minutes and 30 seconds to each station. OSCE stations were duplicated at two sites and were performed twice. After the OSCE, we used structured questionnaires to survey the subjects for their opinions of the current process and the need for an OSCE. RESULTS: At the psychiatric station, which applied an identical scenario and checklists to both the 3rd- and 4th-year medical students, the mean score of the 3rd-year medical students was significantly lower than that of the 4th-year students. The correlation coefficient between OSCE score and cumulative performance grade of 3rd-year medical students (r=0.29) also was lower than that of 4th-year medical students (r=0.53). Over 80% of the 3rd-year medical students and over 90% of the 4th-year responded that an OSCE is necessary. However, around 70% of students preferred an OSCE for each clinical class during clinical clerkship, and only 33~38% of students preferred an OSCE as a final examination. Almost all students wanted to receive feedback after an OSCE. CONCLUSIONS: Performing an OSCE on 3rd-year medical students before they enter clinical clerkship provides better preparation for the clinical clerkship than an evaluation alone. We suggest that an OSCE should be used as a formative assessment in addition to a summative evaluation such as a final examination.