Best fit model of exploratory and confirmatory factor analysis to the 2010 Medical Council of Canada's Qualifying Examination Part I clinical decision making cases / 보건의료교육평가

PURPOSE: This study aims to assess the fit of a number of exploratory and confirmatory factor analysis models to the 2010 Medical Council of Canada's Qualifying Examination Part I (MCCQE1) clinical decision making cases (CDM). The outcomes of this study have important implications for a number of activities, including scoring and test development. METHODS: Candidates included all first-time Canadian medical graduates and international Medical graduates who completed either the spring or fall 2010 test form of the MCCQE1. The fit of one- to five-factor exploratory models was assessed for the 2010 CDM cases item response matrix. Five confirmatory factor analytic models were also examined with the same CDM response matrix. The structural equation modeling software program, Mplus(R) was used for all analyses. RESULTS: Out of five exploratory factor analytic models, a three-factor model provided the best fit. Factor 1 loaded on 3 medicine cases, 2 obstetrics and gynecology cases, and 2 orthopedic surgery cases. Factor 2 corresponded to a pediatrics factor whereas the third factor loads on psychiatry CDM cases. Among the five confirmatory factor analysis models examined in this study, three- and four-factor lifespan period models and the five factor discipline models provided the best fit. CONCLUSION: Above results suggest that broad discipline domains best account for performance on CDM cases. In test development, particular effort should be placed on developing CDM cases according to broad discipline and patient age domains; CDM testlets should be assembled largely using these two constraints i.e. discipline and age.

History of the medical licensing examination (uieop) in Korea's Goryeo Dynasty (918-1392) / 보건의료교육평가

This article aims to describe the training and medical licensing system (uieop) for becoming a physician officer (uigwan) during Korea's Goryeo Dynasty (918-1392). In the Goryeo Dynasty, although no license was necessary to provide medical services to the common people, there was a licensing examination to become a physician officer. No other national licensing system for healthcare professionals existed in Korea at that time. The medical licensing examination was administered beginning in 958. Physician officers who passed the medical licensing examination worked in two main healthcare institutions: the Government Hospital (Taeuigam) and Pharmacy for the King (Sangyakguk). The promotion and expansion of medical education differed depending on the historical period. Until the reign of King Munjong (1046-1083), medical education as a path to licensure was encouraged in order to increase the number of physician officers qualifying for licensure by examination; thus, the number of applicants sitting for the examination increased. However, in the late Goryeo Dynasty, after the officer class of the local authorities (hyangri) showed a tendency to monopolize the examination, the Goryeo government limited the examination applications by this group. The medical licensing examination was divided into two parts: medicine and 'feeling the pulse and acupuncture' (jugeumeop). The Goryeo Dynasty followed the Chinese Dang Dynasty's medical system while also taking a strong interest in the Chinese Song Dynasty's ideas about medicine.

Can a medical regulatory system be implemented in Korea?

The International Association of Medical Regulatory Authorities has suggested three roles for a country's medical regulatory authority: first, it should provide the graduates of medical schools and immigrant physicians licenses to practice in the country; second, it should provide high-quality educational and training programs to promote and maintain the health and safety of the public and ensure professionalism; third, it should resolve public complaints regarding medical practice so as to increase rapport between professionals and the public. In Korea, the first function has been performed by the National Health Personnel Licensing Examination Board. The second function has been executed by the Korean Medical Association as required by medical law since 2012. No authority has been designated to deal with the third function, so this role has been ceded to the legal market. There are three major reasons that the time has come to establish medical regulatory authority in Korea. First, to assure a minimum quality of medical service, more vigorous continuing medical education must be required for licensure. Second, specific and comprehensive preparation should be made available for medical professionals who immigrate, including physicians from North Korea. Third, the establishment of a regulatory authority is the easiest and most reasonable way to establish and promote a level of professionalism that is respected by the public. To establish a medical regulatory authority in Korea, not only physicians but also the government and the public should participate in discussions of this topic. The medical societies should lead the process of discussion, and the societies' agreement with any regulatory outcomes should be obtained.

The Relationship between Senior Year Examinations at a Medical School and the Korean Medical Licensing Examination / 한국의학교육

PURPOSE: Most medical schools prepare for the Korean medical licensing examination (KMLE) with various tests. By assessing the degree to which these exams and the KMLE are related, students, professors, and institutions can be well prepared and some schools use these exams as predictive tools for KMLE scores. Therefore, we determined the relevance of KMLE results to midterm exams and the objective structured clinical examination (OSCE), administered to senior students at a medical school. METHODS: From 2002 to 2004, KMLE results were compared with midterm examinations, the KMLE, and the OSCE. The total score, or T-score, of the KMLE was used, as was a pass or nonpass score. Windows SPSS 14.0 and MedCalc 9.0 were used for statistical analysis. RESULTS: The yearly correlation coefficient of the KMLE and school exams was highest for the midterm exams in 2002 and the KMLE in 2003 and 2004. The correlation coefficient of midterm exams and the KMLE were related to a high degree, yet the values were as low as that of the OSCE. Compared with the KMLE results, the sensitivity and specificity of the average midterm exam were 100.0% and 93.8%, and the sensitivity and specificity of the average trial exams were 100.0% and 95.8%, respectively. CONCLUSION: In conclusion, the KMLE results have a strong relationship with midterm exams, trial exams, and the combination of midterm and trial exams, but not with the OSCE. Thus, we believe that using both midterm exams and trial exams to predict KMLE results is superior to the use of only one type of school exam.

Clinical Performance Assessment as a Model of Korean Medical Licensure Examination / 한국의학교육

BACKGROUND: Evaluation of clinical performance is an essential area for the students who are preparing their career as a medical doctor. However the clinical skills has neither been taught with balanced proportion nor adequately being assessed their abilities. Yet no significant studies on this issue has been reported in Korea so far. The present study was done as a part of preliminary study to seek a model that would be introduced clinical performance assessment in Korean Medical Licensure Examination system. Purpose: The objectives of this study is to develop items of clinical performance and the effective methods to carry out the clinical performance assessment in Korean Medical Licensure Examination system. METHODS: Primary list of clinical performances which was generated through discussion between researchers and medical experts has been distributed to the physicians of various levels. Six hundred ninety seven medical doctors including professors, family physicians, and public health doctors were asked to express their opinion by mail questionnaire. Final items were selected after the reaction of questionnaires and each item has been carefully studied its validity, achievability, and practicality. RESULTS: Thirty five items were selected among fifty one items presented according to the checked number of "essential" and "frequently useful". Seven items were added according to the higher rate of recommendation by open questionnaire. The forty two items were confirmed as a final list which the students should be expected to demonstrate prior to graduation from undergraduate medical school("exit objective"). The OSCE was performed without any serious logistic problems and both examinees and evaluators thought the experience positively. CONCLUSION: To look at the present environment and the readiness it is recommendable to apply the items of psychomotor skills at the beginning for Medical Licensure Examination. For that purpose various medical dolls, kits and subjects can be used.

A Study on the Correlation of Student Achievement and Medical Licensure Examination at Yonsei University, College of Medicine / 한국의학교육

This study analysed the correlation between student achievement and the result of medical licensure examination. To predict the result of pass or fail in the medical licensure examination we carried out a discriminant ana lysis by using following variables: year-wise student academic record and the result of integrative test scores. The prediction ratio was 83.6% and the statistical result is significant. Based on this result the formular of the discriminant score for sucess in medical licensure examination is as following: Z= -19.6372+(0.1812)xcredit of 4th year+(0.0441)xthe result of intergrative test scores. Being considered that the curriculum for seniors was consisted of as core clinical clerkships on the basis of main subjects and the items of medical licensure examination were selected from main subjects. The result is a matter of course. Therefore, it is recommended to put emphasis on core subject-oriented teaching and to strengthen core clinical clerkship to enhence the possiblity of success of medical licensure examination. Since the afore-mentioned discriminant score may predict success of medical licensure examination the school administration can decide to offer special programs for risk group students.