Faculty perceptions and use of e-learning resources for medical education and future predictions.

PURPOSE: This study aims to investigate medical faculties' perceptions and current practice of using e-learning resources, needs and suggestions for more effective use of such resources, and future directions of e-learning in medical education. METHODS: This descriptive study was conducted on full-time faculty members who were registered users of the e-learning portal of the consortium of Korean medical schools. Participants were invited to an online survey containing 45 items that addressed their perceptions and use of e-learning resources, and their predictions of future use. Descriptive analysis and reliability analysis were conducted as well as a thematic analysis of qualitative data. RESULTS: Ninety faculty members from 31 medical schools returned the questionnaires. Participants positively perceived e-learning resources and that they predicted their use would become increasingly popular. Still, only half of the respondents were using e-learning resources for teaching and agreed that they were willing to share their e-learning resources. Our study illustrates several barriers inhibit faculty use and sharing of e-learning resources, and a need for a more comprehensive, better-organized resource repository. Participants also pointed out the needs for more resources on multimedia assessment items, clinical videos, and virtual patients. CONCLUSION: Our study sheds light on medical faculty needs for institutional support and faculty development programs on e-learning, and institutional policies that address faculty concerns regarding ownership, intellectual property rights, and so forth on creating and sharing such resources. Collaborations among medical schools are suggested for creating a better organized around learning outcomes and more comprehensive repository of resources.

Moving forward: embracing challenges as opportunities to improve medical education in the post-COVID era.

Pandemics affect every aspect of life, and Coronavirus Disease 2019 (COVID-19) is no exception. The impact of COVID-19 might be even greater in medical education, which involves close contact with patients. This comment reviews current trends in medical education in response to COVID-19, especially in the pre-clerkship curriculum, and discusses opportunities and challenges in medical education in the post-pandemic era. COVID-19 has accelerated the adoption of online teaching and learning and is expected to boost innovation in medical education. First, blended learning, which is a mix of online and offline learning intended to incorporate the best of both worlds, is expected to become more widespread. Second, more novel approaches to learning that involve student-led initiatives likely become popular mediated by various technologies. Third, there will be more use of online learning resources and assessments. As online learning is expected to play a prominent role in the post-COVID-19 era, such transitions offer both opportunities and challenges. These challenges include faculty development on online teaching skills, creation and sharing of online resources, and effective design and implementation of online assessments. This comment calls for institutional support and collaborations for faculty development and for the development and sharing of learning resources, more models and guidelines for effective technology integration, and use of the virtual learning environment to promote student-centered learning to embrace the challenges as opportunities to improve medical education in the post-COVID era.

Virtual conference participant's perceptions of its effectiveness and future projections.

BACKGROUND: The virtual conference format has become an essential tool for professional development of researchers around the world since the outbreak of the COVID-19 pandemic. This study aims to identify empirical evidence of the benefits and challenges of virtual conferences by investigating participants' experiences with them. METHODS: The study participants were delegates to the 40th annual meeting of the Korean Society of Nephrology, which was held virtually in September, 2020. A questionnaire was developed and implemented among the conference attendees. The 44-item questionnaire included five sub-scales related to participant perceptions of the virtual conference, which were (a) convenience and accessibility, (b) planning and organization, (c) technology use, (d) social exchanges, and (e) overall satisfaction, their preferences of conference formats, and their views of future projections for a virtual conference. RESULTS: A total of 279 delegates completed and returned the questionnaires (18.8% response rate). Participants varied in gender, age, profession, work location, and prior experience with conferences. On a four-point Likert scale (1 = "strongly disagree" and 4 = "strongly agree"), participants showed positive perceptions of the virtual conference in general, where the total mean (M) was 3.03 and less positive perceptions on social exchanges (M = 2.72). Participant perceptions of the virtual conference differed across age groups, professions, and prior experience with conferences (p < .05). Approximately half of the participants (n = 139) preferred the virtual format, and 33% (n = 92) preferred the conventional format. Participant preferences for the virtual format were somewhat evenly distributed between asynchronous (32.9%) and synchronous (29.1%) modes. Participants predicted a virtual conference would continue to be a popular delivery format after the end of the COVID-19. CONCLUSIONS: Although participants had positive perceptions of the virtual conference, more support needs to be offered to those who may be less comfortable with using technology or with online interactions, and there is a need for improvement in supporting social exchange among attendees. Also, it is suggested that a blend of asynchronous and synchronous delivery methods should be considered to meet the varied needs of attendees.

e-Learning for enhancement of medical student performance at the Objective Structured Clinical Examination (OSCE).

This study aimed to investigate the impact of student e-learning on the development of clinical competencies. The study participants were 3rd year students (n = 43) at a private mid-sized medical school located in a South Korean suburb on a four-year medical program. Educational intervention was implemented to enhance student clinical performance. Students engaged in learning activities that intended to promote their self-directed learning abilities and clinical performances using e-learning resources. Intervention was conducted for the duration of six months during the 3rd year and its effectiveness was investigated by comparing student performances in OSCEs in a pre- and post- comparison format and also by comparing them with national scores. In addition, student perceptions of the impact of e-learning on their OSCE performances were assessed using a questionnaire, which included 36 items that elicited student perceptions of their experiences of e-learning and readiness for e-learning. Student OSCE scores improved significantly after educational intervention in all domains of clinical competencies assessed and for total scores (p < 0.001). Furthermore, students achieved higher OSCE scores than national average scores in the post-test, whereas they had performed lower than national average scores in the pre-test. Students showed neutral or slightly positive responses to the effectiveness of e-learning, and their perceptions of e-learning were not associated with their e-learning readiness scores. The study shows student OSCE performance improved significantly after educational intervention, which indicate the effectiveness of e-learning to support student learning of clinical performance. Despite significant improvements in student OSCE scores after e-learning, their perceptions of its effectiveness were neutral. Furthermore, student perceptions of e-learning were not associated with their readiness for it. Suggestions are made to help students use e-learning more effectively to enhance their clinical competencies.

A validation study of the Korean version of the Toronto empathy questionnaire for the measurement of medical students' empathy.

BACKGROUND: This study aimed to validate the Korean version of the Toronto Empathy Questionnaire (TEQ) and to determine its suitability for the measurement of empathy in medical students. METHODS: The study sample was Year 1 and 2 medical students at two medical schools on six-year undergraduate medical programs in South Korea. The study participants completed the Korean TEQ, which has a single factor structure and consists of 16 items; responses are scored using a 5-point Likert scale, giving a maximum possible score of 64. Psychometric validation of the questionnaire was performed by exploratory and confirmatory factor analyses and the goodness of fit test. Average variance extracted was calculated to establish convergent validity, and associations between factors and construct reliability were analyzed to establish discriminant validity. Cronbach's alpha values were utilized for reliability analysis. RESULTS: A total of 279 students completed and returned the questionnaire (a 96.2% response rate). Participant empathy scores ranged from 20 to 60 (M = 44.6, SD = 7.36). Empathy scores were higher for females than males (p < .05). The cumulative variance of the Korean TEQ was 32%, indicating that its explanatory power was rather weak. Consequently, goodness-of-fit testing was performed on four hypothetical models, among which a three-factorial structure consisting of 14 items demonstrated satisfactory fit indices and explained 55% of the variance. Reliability estimates of the three subscales were also satisfactory (Cronbach's α = .71-.81). This three-factorial model was validated by confirmatory factor analysis and demonstrated adequate convergent and discriminant validity. CONCLUSIONS: This study demonstrated psychometric validation of the Korean TEQ for measuring medical students' empathy. We suggest a modified 14-item model with a three-factorial structure, which demonstrated better psychometric properties than the original scale.

Benefits and Feasibility of Using Videos to Assess Medical School Applicants' Empathetic Abilities in Multiple Mini Interviews.

Purpose: We sought to evaluate the feasibility and benefits of using video-based scenarios in Multiple Mini Interviews (MMIs) to assess candidate's empathic abilities by investigating candidate perceptions and the acceptability, fairness, reliability, and validity of the test. Methods: The study sample was candidates for admission interviews held in the MMI format at a medical school in South Korea. In this six-station MMI, one station included a 2-min video clip of a patient-doctor communication scenario to assess candidate emphatic abilities, whereas paper-based scenarios were used in the other stations. Candidate's perceptions and acceptability of using the video-based scenario in the empathy station were examined using a 41-item post-MMI questionnaire. Fairness of the test was assessed by means of differences in candidate perceptions and performance across different demographics or backgrounds. Construct validity was assessed by examining the relationship of candidate performances in the empathy station with those in other stations. The G-coefficient was analyzed to estimate the reliability of the test. Results: Eighty-two questionnaires were returned, a 97.6% response rate. Candidates showed overall positive perceptions of the video-based scenario and they found it authentic and interesting. The test was fair as there were no differences in candidates' perceptions of the patient-doctor relationship presented in the video clip and neither in their performance nor in their perceived difficulty of the station across demographics or backgrounds. Construct validity was established as candidate performance in the empathy station was not associated with that of any other stations. The G-coefficient was 0.74. Conclusions: The present study demonstrates that the video-based scenario is a feasible tool to assess candidate's empathy in the MMI.

The efficacy of peer assessment in objective structured clinical examinations for formative feedback: a preliminary study.

PURPOSE: We sought to determine the impact of medical students' prior experience of assessing peers in the objective structured clinical examination (OSCE) on their clinical performance. METHODS: Forty-two year 4 medical students participated in an OSCE comprised of three 10-minute stations (syncope, hemoptysis, and back pain). Each student took part in two iterations of the three-station OSCE as either the examiner or examinee, and student performance was assessed using a checklist by a medical faculty member and a student simultaneously. Students were randomly assigned to two groups and their OSCE scores were compared. Students in the control group were tested at a station first and then participated at the same station as a peer examiner, and those in the intervention group participated as a peer examiner first and then as an examinee. Moreover, student OSCE scores rated by peer examiners were compared with those awarded by faculty to evaluate the accuracy of peer assessment. Following the test, students completed surveys on their perceptions of the usefulness of this formative OSCE. RESULTS: Student overall OSCE scores did not differ between groups. Students in the study group performed better at the hemoptysis station (p<0.001), but poorer at the syncope station (p<0.01). Student performances at the back-pain station were similar in these two groups (p=0.48). OSCE scores rated by faculty and peer examiners were moderately negatively associated at the hemoptysis station (p<0.05), but no such association was observed at the other two stations. This trend was similar in peer examiners who were high-achievers and low-achievers in OSCEs. Students showed positive perceptions of their experience with this OSCE. CONCLUSION: Student experience as peer assessor offers a feasible means of providing them greater access to OSCEs without consuming more resources, although its impact on enhancing performance in the OSCE is likely to differ across stations.

Project-based learning approach to increase medical student empathy.

This study investigated the impact of empathy training on medical students using a project-based learning approach on the development of their empathic abilities. Study participants were Year 2 students in the six-year medical program, to whom a one credit-hour course on empathic communication was offered over a semester. In this course, students worked on collaborative team projects in which they were asked to interview a person and to report the empathy that they shared with the interviewee. Development in student empathy was measured using the Interpersonal Reactivity Index inventory in a pre- and post-test format over the semester and their reflective reports were qualitatively analyzed to identify emerging themes on the lessons they learned from the project experience. A total of 45 students completed the questionnaires (a 97.8% response rate). Students' overall empathy scores did not change over time (t = 1.943, p = .06). Still, students with lower empathy in the pre-test improved significantly in their empathy scores (t = 3.44, p < .01). Students reported that the empathy project was beneficial in improving their understanding of empathy and enhancing their empathic communication skills. This study shows the project-based learning approach was effective in developing medical student empathy especially for those with lower empathy.

Development of e-learning in medical education: 10 years' experience of Korean medical schools.

PURPOSE: We aimed to explore medical students' online learning patterns and needs by analyzing data obtained from an e-learning portal of Korean medical schools. METHODS: Data were obtained from learning resources and registered users of the e-learning portal by the consortium of 36 Korean medical schools, e-MedEdu (www.mededu.or.kr) over a period of 10 years. Data analytics were performed of its contents and usage patterns using descriptive statistics. RESULTS: The website currently has over 1,600 resources, which have almost tripled over the past decade, and 28,000 registered users. Two hundred and twenty medical faculty have contributed the resources; a majority of them were clinical cases and video clips, which accounted for 30% and 27% of all resources, respectively. The website has received increasing hits over the past decade; annual website hits increased from 80,000 in 2009 to over 300,000 in 2018. The number of hits on resources varied across resource types and subjects; 90% of all website hits were on online videos, and 28% of them originated from mobile devices. Among the online videos, those on procedural skills received more hits than those on patient encounters and video lectures. CONCLUSION: Our findings demonstrate the increasing use of e-learning in medical education in Korea over the past decade. Our study also shows a wide disparity in the frequency of use in learning resources across resource types and subjects, which have implications for improvements in the design and development of learning resources to better meet medical students' curricular needs and their learning styles.

Enhancing students' active learning and self-efficacy using mobile technology in medical English classes.

PURPOSE: This study investigated student experiences of mobile technology in a medical English course using a free mobile classroom application, Socrative and its impact on student learning to help them achieve the competency expected in the course. METHODS: Questionnaires were administered of year 2 medical students enrolled in a medical English course between 2016 and 2017 to investigate their experience in using Socrative. Learning outcomes were assessed by comparing students' academic performance with that of the 2015 cohort, who had taken the same course without using mobile technology, and also by measuring changes in their self-efficacy in English over time during the course. RESULTS: This study found students' positive perceptions of and overall satisfaction with their experience in using mobile technology in the medical English course. There were no differences in the academic performance between the study cohort and the comparison group. The ratio of students who were in the remediation program after the mid-term examination was 11%, whereas the remediation ratio of the 2015 cohort was 21%. Students' self-efficacy in English improved significantly in the writing and reading domains (p<0.05). CONCLUSION: This study found several benefits of using Socrative in the medical English course. Socrative fostered the classroom interaction by encouraging input from every student and sharing it instantly with the whole class. There was also learning improvement with the use of Socrative. Furthermore, it has the potential to enhance assessment by offering more various forms of assessment than that of conventional audience response systems.

Factors That Influence Attitudes Toward End-of-Life Care Among Medical Students: Nationwide Survey for Fourth-Year Korean Medical Students.

BACKGROUND: Positive attitudes for end-of-life (EOL) care along with adequate education are key factors for the provision of quality EOL care. This national study was conducted to identify the factors that influence attitudes toward EOL care on medical students. METHOD: An anonymous survey was designed and administered to fourth-year medical students at all 41 medical schools in Korea. Topics related to EOL care were assessed in classroom teaching, bedside teaching, and feedback experiences during clinical clerkships. Seven questions for self-rated attitudes and affecting factors were analyzed toward EOL care. RESULTS: With a response rate of 49.2%, the median number of topics recognized by the students as having been delivered was 5 of 11 topics in classroom lectures and 1 of 8 topics in clinical experience. Although few (21.2%) participants indicated that they felt ready for EOL care practice, nevertheless, most felt that they should have adequate knowledge of and preparation for clinical competency in EOL care. Several parameters including respondent's demographics and exposure to EOL care topics in classroom and in bedside teaching influenced the responses to all 7 attitude questions. However, having more than 1 bedside experience was the only factor positively affecting all attitudinal measures. CONCLUSIONS: Clinical experience related to EOL care seems to be the utmost priory in fostering positive attitudes and competency among medical students.

Enhancement of student perceptions of learner-centeredness and community of inquiry in flipped classrooms.

BACKGROUND: Flipped classrooms (FC) are expected to create a more student-centered, active learning environment than traditional lectures. This study assessed the effectiveness of FC in promoting a student-centered, active learning environment by examining the changes in student perceptions of the learning environment of FC in terms of student-centeredness and sense of community of inquiry (COI), which represents the elements of a successful learning environment. METHODS: Questionnaires were given to a cohort of Year 2 students in a six-year undergraduate medical education program, who had taken an introduction to medicine course in a FC format. The questionnaire included 7 items on the teaching orientation (i.e., teacher-centered vs. student-centered) and 34 items from the Community of Inquiry Survey Instrument, which consisted of three sub-scales - teaching, social, and cognitive presences. The questionnaires were administered in pre- and post-test format during the first and last week of the semester. RESULTS: A total of 55 students returned the questionnaires (100% response rate). The student perceptions of student-centeredness of FC increased significantly over time (p < 0.001), and their perceptions of COI in FC also increased significantly in all three presences (p < 0.001). The student perceptions of student-centeredness and sense of COI in FC increased significantly in both high-achieving and low-achieving students (p < 0.01). CONCLUSIONS: This study indicates that the flipped classroom model is an effective approach to fostering a learner-centered learning environment and developing a community of inquiry among medical students.

Does the sequence of rotations in Multiple Mini Interview stations influence the candidates' performance?

In Multiple Mini Interviews (MMIs), the candidates start out with different stations depending on the sequence of rotation they are assigned; thus, their perceived difficulty level and nervousness with their first station may differ. We examined whether such differences influenced the candidates' overall performance in the MMI. A 32-item questionnaire was developed and administered to candidates for admission interviews at a medical school regarding their perceptions of the MMI. Candidates' interview scores were also obtained and were compared across groups who differed in the sequence of rotation of MMI stations. Candidates felt nervous when they encountered the first station, which did not differ regardless of which station was their first encounter. Candidates were neutral regarding whether their first station was more difficult than the others and about whether its difficulty level influenced their overall performance in the test. Although candidates' perceived station difficulty differed across stations, there were no differences in their performance in each station between those it was their first station and those it was not. Candidates' total interview scores also did not differ across groups of different sequence of rotations. The MMI is a fair process as it does not give disadvantage to those who encounter a more difficult station than others for their first station.

Survey on the undergraduate curriculum in clinical pharmacology and interns' prescribing ability in South Korea.

Appropriate prescription writing is one of the critical medical processes affecting the quality of public health care. However, this is a complex task for newly qualified intern doctors because of its complex characteristics requiring sufficient knowledge of medications and principles of clinical pharmacology, skills of diagnosis and communication, and critical judgment. This study aims to gather data on the current status of undergraduate prescribing education in South Korea. Two surveys were administered in this study: survey A to 26 medical schools in South Korea to gather information on the status of undergraduate education in clinical pharmacology; and survey B to 244 intern doctors in large hospitals to gather their opinions regarding prescribing education and ability. In survey A, half of the responding institutions provided prescribing education via various formats of classes over two curriculums including lecture, applied practice, group discussions, computer-utilized training, and workshops. In survey B, we found that intern doctors have the least confidence when prescribing drugs for special patient populations, especially pregnant women. These intern doctors believed that a case-based practical training or group discussion class would be an effective approach to supplement their prescribing education concurrently or after the clerkship in medical schools or right before starting intern training with a core drug list. The results of the present study may help instructors in charge of prescribing education when communicating and cooperating with each other to improve undergraduate prescribing education and the quality of national medical care.

Characteristics of medical teachers using student-centered teaching methods.

PURPOSE: This study investigated characteristics of medical teachers who have adopted student-centered teaching methods into their teaching. METHODS: A 24-item questionnaire consisted of respondent backgrounds, his or her use of student-centered teaching methods, and awareness of the school's educational objectives and curricular principles was administered of faculty members at a private medical school in Korea. Descriptive statistics and chi-square analysis were conducted to compare faculty use of student-centered approaches across different backgrounds and awareness of curricular principles. RESULTS: Overall response rate was 70% (N=140/200), approximately 25% (n=34) of whom were using student-centered teaching methods. Distributions in the faculty use of student-centered teaching methods were significantly higher among basic sciences faculty (versus clinical sciences faculty), with teaching experiences of over 10 years (versus less than 10 years), and who were aware of the school's educational objectives and curricular principles. CONCLUSION: Our study indicates differences in medical faculty's practice of student-centered teaching across disciplines, teaching experiences, and their understanding of the school's educational objectives curricular principles. These findings have implications for faculty development and institutional support to better promote faculty use of student-centered teaching approaches.

The gap between medical faculty's perceptions and use of e-learning resources.

BACKGROUND: e-Learning resources have become increasingly popular in medical education; however, there has been scant research on faculty perceptions and use of these resources. OBJECTIVE: To investigate medical faculty's use of e-learning resources and to draw on practical implications for fostering their use of such resources. DESIGN: Approximately 500 full-time faculty members in 35 medical schools across the nation in South Korea were invited to participate in a 30-item questionnaire on their perceptions and use of e-learning resources in medical education. The questionnaires were distributed in both online and paper formats. Descriptive analysis and reliability analysis were conducted of the data. RESULTS: Eighty faculty members from 28 medical schools returned the questionnaires. Twenty-two percent of respondents were female and 78% were male, and their rank, disciplines, and years of teaching experience all varied. Participants had positive perceptions of e-learning resources in terms of usefulness for student learning and usability; still, only 39% of them incorporated those resources in their teaching. The most frequently selected reasons for not using e-learning resources in their teaching were 'lack of resources relevant to my lectures,' 'lack of time to use them during lectures,' and 'was not aware of their availability.' CONCLUSIONS: Our study indicates a gap between medical faculty's positive perceptions of e-learning resources and their low use of such resources. Our findings highlight the needs for further study of individual and institutional barriers to faculty adoption of e-learning resources to bridge this gap.

The utility of multiple mini-interviews: experience of a medical school.

PURPOSE: This paper aims to introduce the design of multiple mini-interviews (MMIs) as a tool to assess medical school applicants' attributes in alignment with the school's educational goals and to evaluate its utility. METHODS: In this MMI, candidates rotated through six stations (10 minutes per station), in which specific interview topics were drawn by mapping the school's educational goals with the core competencies for entering medical students. We conducted post-MMI surveys of all of the interviewers and candidates to investigate their experiences of MMIs. The G-coefficient and interclass correlation were analyzed to investigate the reliability of this test. Additionally, the candidates' MMI scores were compared across different backgrounds and a univariate analysis was used to estimate correlations between their MMI scores and prior academic achievements. RESULTS: A total of 164 candidates (a 98.8% response rate) and 19 interviewers (a 100% response rate) completed the surveys in the years 2014 and 2015. Both candidates and assessors showed positive responses to MMIs. The G-coefficient of MMI scores was 0.88 and the interclass correlation coefficients ranged from 0.58 to 0.75. The participants' total MMI scores did not differ across genders or undergraduate backgrounds and were not associated with age, undergraduate graduate point averages, nor the Korean medical school admission test (Medical Education Eligibility Test) scores. CONCLUSION: Our study illustrates the utility of MMIs that utilize the institution's educational goals to identify attributes to be pursued in the admission interviews in alignment with the institution's core values. Future research is warranted of the predictive validity of this MMI.

Factors associated with medical student test anxiety in objective structured clinical examinations: a preliminary study.

OBJECTIVES: To investigate attributes of medical students associated with their test anxiety on Objective Structured Clinical Examinations (OSCEs). METHODS: A cross-sectional study using a self-administered questionnaire was conducted of all Year 3 and 4 students at a private medical school in South Korea in 2014. This 53-item questionnaire consisted of factors pertaining to test anxiety on the OSCE identified from a review of relevant literature, which included students' motivational beliefs and achievement emotions, perceived values of the OSCE, and attitude and orientation towards patients. Participants' test anxiety levels were measured using the Korean Achievement Emotions Questionnaire. Participants rated their responses using a five-point Likert-type scale. Univariate analysis was performed to examine relationships between the variables. RESULTS: A total of 94 students completed the questionnaire (a 93% response rate). No differences in the participants' test anxiety scores were observed across genders, entry-levels, or years in medical school. Participants' test anxiety on the OSCE showed moderate association with their class-related achievement emotions (i.e., anxiety and boredom), where r = 0.46 and 0.32, p < 0.01, respectively, and weak negative associations with their patient-centeredness (r = -0.21, p < 0.05) and with their perceived values of the OSCE (r = -0.21, p < 0.05). CONCLUSIONS: This study found some non-cognitive factors related to medical students' test anxiety on the OSCE. These findings have implications for developing effective educational interventions for helping students cope with such a stress by enhancing our understanding of the various factors that influence their test anxiety in OSCEs.