Faculty Observer and Standardized Patient Accuracy in Recording Examinees' Behaviors Using Checklists in the Clinical Performance Examination / 한국의학교육

PURPOSE: The purpose of the study was to examine the recording accuracy of faculty observers and standardized patients (SPs) on a clinical performance examination (CPX). METHODS: This was a cross-sectional study of a fourth-year medical students' CPX that was held at a medical school in Seoul, Korea. The CPX consisted of 4 cases and was administered to 118 examinees, with the participation of 52 SP and 45 faculty observers. For the study we chose 15 examinees per case, and analyzed 60 student-SP encounters in total. To determine the recording accuracy level, 2 SP trainers developed an answer key for each encounter. First, we computed agreement rates (P) and kappa coefficient (K) values between the answer key-SPs and the answer key-faculty observers. Secondly, we analyzed variance (ANOVA) with repeated measures to determine whether the mean percentage of the correct checklist score differed as a function of the rater, the case, or the interaction between both factors. RESULTS: Mean P rates ranged from 0.72 to 0.86, while mean K values varied from 0.39 to 0.59. The SP checklist accuracy was higher than that of faculty observersat the level of item comparison. Results from ANOVA showed that there was no significant difference between the percentage of correct scores by the answer key, faculty observers and SPs. There was no significant interaction between rater and case factors. CONCLUSION: Acceptable levels of recording accuracy were obtained in both rater groups. SP raters can replace faculty raters in a large-scale CPX with thorough preparation.

Development and Validation of a Questionnaire to Evaluate Medical Students' Evidence-Based Medicine Competencies / 한국의학교육

PURPOSE: The purpose of the study was to develop and validate a questionnaire to evaluate medical students' knowledge of, attitude towards and practice of evidence-based medicine (EBM). METHODS: The participants of the study were 418 medical students enrolled in the Kyung Hee University School of Medicine in Seoul, Korea. To examine construct validity of the questionnaire, an exploratory factor analysis (EFA) was performed with 118 participants; a confirmatory factor analysis (CFA) was conducted with the remaining 281 participants. We developed 41 items with a 4-point Likert scale. An EFA was performed to verify the emergence of four dimensions of EBM competencies. The principal axis factoring method and the direct oblimin rotation method were used. To confirm construct validity, a CFA was conducted with the remaining 281 participants. To evaluate model fitness, root mean square error of approximation (RMSEA) and comparative fit index (CFI) were used as fit indices. We conducted ANOVA with Scheffe as discriminant validation, and calculated Cronbach's alpha of 4 subscales as reliability checkup. RESULTS: After refinement procedure, factor analysis of the 32 items in therevised questionnaire yielded 4 factors. The Scree plot supported a 4 factor solution explaining 53.5% of the variance. The 4 components derived were: factor 1_knowledge on EBM (11 items; Cronbach's alpha=0.92); factor 2_ pursuit towards EBM (10; 0.88); factor 3_reluctance on EBM (7; 0.78); factor 4_practice of EBM (4; 0.75). The questionnaire could discriminate competence differences among 1-3 yr students. Satisfactory Cronbach's alpha scores were noted for each factor as well. CONCLUSION: The EBM competency questionnaire was validated.

Development and Validation of a Questionnaire to Evaluate Medical Students' Evidence-Based Medicine Competencies / 한국의학교육

PURPOSE: The purpose of the study was to develop and validate a questionnaire to evaluate medical students' knowledge of, attitude towards and practice of evidence-based medicine (EBM). METHODS: The participants of the study were 418 medical students enrolled in the Kyung Hee University School of Medicine in Seoul, Korea. To examine construct validity of the questionnaire, an exploratory factor analysis (EFA) was performed with 118 participants; a confirmatory factor analysis (CFA) was conducted with the remaining 281 participants. We developed 41 items with a 4-point Likert scale. An EFA was performed to verify the emergence of four dimensions of EBM competencies. The principal axis factoring method and the direct oblimin rotation method were used. To confirm construct validity, a CFA was conducted with the remaining 281 participants. To evaluate model fitness, root mean square error of approximation (RMSEA) and comparative fit index (CFI) were used as fit indices. We conducted ANOVA with Scheffe as discriminant validation, and calculated Cronbach's alpha of 4 subscales as reliability checkup. RESULTS: After refinement procedure, factor analysis of the 32 items in therevised questionnaire yielded 4 factors. The Scree plot supported a 4 factor solution explaining 53.5% of the variance. The 4 components derived were: factor 1_knowledge on EBM (11 items; Cronbach's alpha=0.92); factor 2_ pursuit towards EBM (10; 0.88); factor 3_reluctance on EBM (7; 0.78); factor 4_practice of EBM (4; 0.75). The questionnaire could discriminate competence differences among 1-3 yr students. Satisfactory Cronbach's alpha scores were noted for each factor as well. CONCLUSION: The EBM competency questionnaire was validated.

Inter-rater Reliability in a Clinical Performance Examination Using Multiple Standardized Patients for the Same Case / 한국의학교육

PURPOSE: The "standardization" of standardized patients (SP) is one of the most crucial factors for a successful clinical performance examination (CPX). This study aimed to examine the inter-rater reliability among SPs who portrayed the same case during a CPX. METHODS: The context was a CPX conducted under the supervision of CPX Seoul-Gyeonggi Consortium in K medical school in August 2007. K medical school ran 12 stations consisting of duplicated sets of 6 cases. In total, thirty SPs participated with 5 SPs acting each of the 6 cases. The SPs evaluated the student's performances in addition to portraying the cases. ANCOVA (analysis of covariance) was used to compare scores rated by the different SPs. The dependent variables were the case scores and the 4 subcomponent (history taking, physical examination, Clinical courtesy, and Patient-physician interaction) scores for each case; the independent variable was the SPs; and the covariate was the CPX total score. RESULTS: The Headache and Cough stations showed an acceptable level of reliability. Otherwise, Weight Loss and Facial Flushing failed to show consistent scores in all 4 subcomponents. Diarrhea and Lt. hemiparesis showed partial consistency. In terms of the subcomponents, the physical exam scores were most consistent and the patient-physician interaction scores were most inconsistent. CONCLUSION: This study tested the level of "standardization" of one set of CPX cases with mixed results. The authors hope that our results will contribute to quality assurance of CPX.

The Effects of Coping Style on Subjective Well-Being Among Medical Students / 한국의학교육

PURPOSE: This study aims to explore which coping strategies medical students use more often, and how coping styles account for medical students' subjective well-being. METHODS: Subjects included 249 medical students from undergraduate and Graduate Entry Programme of a medical school in Seoul, Korea. Coping style was measured using the Ways of Coping Checklist. Subjective well-being was measured with Positive/Negative Affect Scale and Satisfaction with Life Scale. Analysis of Variance(ANOVA) was used to compare four coping strategies, and stepwise multiple regression was used to analyze the accountability of each of the coping strategy for subjective well-being. RESULTS: Medical students used avoidance and problem-focused coping strategy more often than they used emotion-focused coping strategy and seeking social support. Graduate Entry Programme students used avoidance less often and seeking social support more often than undergraduate students. Among subscales of subjective well-being, positive affect can be accounted for by problem-focused coping and seeking social support, and negative affect can be accounted for by problem-focused coping and avoidance. Life satisfaction can be accounted for by problem-focused coping as well. CONCLUSION: The results of this study showed that medical students had high adaptability as well as strong anxiety toward stressful situations in medical school. Moreover, three among the four coping strategies accounted for medical students' subjective well-being. These findings should be considered as a baseline for future research looking into additional variables affecting medical students' well-being.