5. The 2022 Revision of the Model Core Curriculum for Medical Education in Japan and the Common Achievement Test Being Made an Official Requirement / Participatory Clinical Clerkship / 医学教育

Following the revision of the structure and content of the Model Core Curriculum for Medical Education to be more outcome-based and the legal status of the medical practice performed by medical students in the clinical clerkship, we have revised the Guideline for Participatory Clinical Clerkship. The following items were revised or newly described : significance of enhancing the participatory clinical clerkship, scope of medical practice, confidentiality, patient consent, patient consultation and support service, objectives of the clinical clerkship, simulation education, departments where the clinical clerkship is conducted, assessment in the clinical practice setting, CC-EPOC, and entrustable professional activities. A foundation has been established to promote seamless undergraduate and postgraduate medical education. However, future work is needed to examine the specific level of performance expected at the end of the clinical clerkship and department-specific clinical practice goals and educational strategies.

Present undergraduate medical education with connection to Postgraduate education / 医学教育

Medical education at college is the very first step of life-long learning as a medical doctor. Curricular reforms in Japan took place in the early 21st century, and can be exampled by the development of a model core curriculum, the emergence of the CAT (common achievement test) examination, the development of clinical clerkship and so on. The International accreditation of medical schools has just started spring of 2017. It highlights outcome-based education, which accelerates the connection of undergraduate education with postgraduate training.

Study of correlations between the examinees' results on the basic objective structured clinical examination (OSCE), computer-based testing, and the advanced OSCE / 医学教育

Studying the correlation between the results of the Common Achievement Test (basic objective structured clinical examination [OSCE] and computer-based testing [CBT]) and the results of advanced OSCE in the same examinees is necessary to improve clinical clerkships and to establish the role of each examination.<BR>1) Ninety-seven students took the Common Achievement Test CBT and the basic OSCE in their fourth year and took the advanced OSCE in their sixth year. The Common Achievement Test basic OSCE were composed of interview, chest, abdomen, neurology, and head and neck stations, and the CBT included blocks 1-4 and 5-6. The advanced OSCE had 3 scenarios in the chest station, 2 in the abdomen station, and 4 in the neurology station. Each scenario had 3 items. We also examined the pass analysis on the basis of these 3 items in the advanced OSCE.<BR>2) The results of the Common Achievement Test basic OSCE interview did not correlate significantly with the results of the interview station of the advanced OSCE. The results of physical examinations in the Common Achievement Test basic OSCE, excluding the chest, did not correlate significantly with the results of the physical examination stations of the advanced OSCE.<BR>3) In the advanced OSCE, an adequate medical interview is necessary for the physical examination. An adequate physical examination is also necessary for answering the written tests (e.g., differential diagnosis). 4) Students should have sufficient basic knowledge and motivation for successfully performing clinical clerkships, because the correlations among the results of the advanced OSCE interview, the OSCE total score, the Common Achievement Test basic OSCE and CBT score were extremely strong.<BR>5) The advanced OSCE, the Common Achievement Test basic OSCE, and CBT have distinct characteristics and roles.

Analysis of the Questionarre for Nationwide Common Achievement Test System for Entering Clinical Clerkship in Japan / 医学教育

Nationwide common achievement test system for entering clinical clerkship will formally start from December 2005. Before the start, four times trial examination were carried out. Based on these trials, some problems for the test sytem were pointed out. We have analysed the problems proposed to induce more suitable examination system.

Statistical Analysis with the Item-Response Theory of the First Trial of the Computer-Based Nationwide Common Achievement Test in Medicine / 医学教育

Data from the first trial of the computer-based nationwide common achievement test in medicine, carried out from February through July in 2002, were analyzed to evaluate the applicability of the item-response theory. The trial test was designed to cover 6 areas of the core curriculum and included a total of 2791 items. For each area, 3 to 40 items were chosen randomly and administered to 5693 students in the fourth to sixth years; the responses of 5676 of these students were analyzed with specifically designed computer systems. Each student was presented with 100 items. The itemresponse patterns were analyzed with a 3-parameter logistic model (item discrimination, item difficulty, and guessing parameter). The main findings were: 1) Item difficulty and the percentage of correct answers were strongly correlated (r=-0.969to-0.982). 2) Item discrimination and the point-biserial correlation were moderately strongly correlated (r=0.304 to 0.511). 3) The estimated abilities and the percentage of correct answers were strongly correlated (r=0.810 to 0.945). 4) The mean ability increased with school year. 5) The correlation coefficients among the 6 curriculum area ability scores were less than 0.6. Because the nationwide common achievement test was designed to randomly present items to each student, the item-response theory can be used to adjust the differences among test sets. The first trial test was designed without considering the item-response theory, but the second trial test was administered with a design better suited for comparison. Results of an analysis of the second trial will be reported soon.

Effect of Workshops for Preparing Multiple-Choice Questions for Computer-Based Testing Used in the Nationwide Common Examination Before Clinical Clerkships / 医学教育

Computer-based testing (CBT) has been used in Japan since 2002 to assess medical students' basic and clinical medical knowledge, based on the model core-curriculum, before they start clinical clerkships. For effective CBT, multiplechoice questions must accurately assess the knowledge of students. Questions for CBT are submitted by all medical schools in Japan. However, only 40% of questions are chosen for CBT and used at random; the other 60% of questions are rejected because of poor quality. Toimprove the ability of medical staff to devise questions, workshops were held at 30 medical schools. The acceptance rate of questions from schools where workshops were held was significantly increased. The workshops were extremely effbctive for improving the quality of questions.

Report of the First Trial of Nationwide Common Achievement Test-Computer-Based Testing in Medicine / 医学教育

The first trial of common achievement test-computer-based testing was held from January through August 2002. The number of examinees was 5, 693, of whom 5, 676 were analyzed. Single-best-answer, five-choice questions were used. The highest score was 92 points, the lowest score was 19 points, and the average score was 55.9±10.2 points (standard deviation). Scores were distributed normally. The test sets did not differ significantly in difficulty, although test-set items differed for each student. The percentage of correct answers, the ∅-coefficient, and the point-biserial correlation coefficient were calculated for each category of the model core curriculum. The percentage of correct answers was highest in category A of the model core curriculum, and percentages of correct answers were similar in categories B, C, D, E, and F. The ∅-coefficient and the correlation coefficient were low in categories A and F and were highest in category C. Although the percentage of correct answers in this trial was lower than expected, many test items had discriminatory power. The Test Items Evaluation Subcommittee is now evaluating test items, determining pool items, and revising new test items for the second trial and expect to compile a useful item bank.

Problems in Preparing Multiple Choice Questions for Computer-based Testing Used in the Nationwide Common Examination before Clinical Clerkships / 医学教育

In 2002, Japanese medical students began computer-based testing (CBT) to assess their basic and clinical medical knowledge, based on the model core-curriculum, before starting clinical clerkships. Of 9, 919 multiple choice questions submitted by 80 medical schools, 2, 791 were used for CBT and 7, 128 were rejected. To improve the quality of future CBT, we analyzed why questions were rejected. The most commons reasons were difficulty, length, and inappropriate choice of answers. A training course may be needed to improve the ability of medical school staff to devise questions.