Purpose To develop and validate a structured oral clinical assessment (SOCA) tool to evaluate pharmacotherapy competencies among medical students during clinical clerkships.
Methods The instrument was designed around seven core pharmacotherapy domains. A total of 30 pharmacology experts participated in the face and content validity assessments. The cognitive complexity was evaluated using Bloom’s taxonomy. Nine trained examiners assessed 77 clerkship students using the SOCA tool. Construct validity was tested using Spearman correlation, whereas inter-rater reliability was analyzed using Cohen’s kappa and Krippendorff’s alpha. Internal consistency was assessed using Cronbach’s alpha.
Results All items showed strong content validity (item-level content validity index and face validity index=1.00). Most questions reflected moderate to high cognitive complexity (Bloom’s C2–C5). Construct validity was supported by significant domain-total score correlations (r=0.406–0.750; p<0.05). Inter-rater reliability was substantial (kappa=0.651–0.830; Krippendorff’s alpha=0.639–0.834), and internal consistency was acceptable (Cronbach’s alpha=0.759).
Conclusion The SOCA tool has strong validity and reliability for evaluating pharmacotherapy competence through oral clinical examination. It offers a structured, feasible alternative to existing formats and has the potential for broader use following external validation.
Purpose The COVID-19 (coronavirus disease 2019) pandemic led to significant changes in clinical clerkships, including reduced ward rounds. We aimed to determine how the pandemic–induced changes in the clinical practice environment affect the clinical performance of medical students.
Methods We analyzed objective structured clinical examination scores of third- and fourth-year medical students from 2019–2020 and 2020–2021 across six stations by the Seoul–Gyeonggi Consortium. Clinical, communication, and ability scores were measured and analyzed using repeated-measures multivariate analysis of variance.
Results The interaction between clinical practice progress and pandemic-induced changes significantly affected physical examination and medical history scores, though the differences were not substantial. Patient-physician interaction significance varied by measurement period. Clinical communication ability also showed significant differences based on the measurement period and practical experience.
Conclusion During the pandemic, alternative learning methods, including self–learning, simulation/practice, and peer role–play, helped improve medical competency in areas such as history–taking and physical examination. However, these were less effective in improving patient–physician interactions or clinical communication efficacy. Alternative learning methods have limitations, and they cannot replace direct patient encounters in clinical practice.
Purpose The practice of feedback is influenced by the characteristics of students, teachers, and the clinical environment. Most studies on feedback have been conducted in Western settings with different sociocultural backgrounds to Indonesia. This study explores feedback in Indonesian clinical clerkship using a sociocultural lens and aims to provide an exemplar of adaptive practice relevant to non-Western settings.
Methods This qualitative study was conducted using an interpretive phenomenology approach. Data were collected through focus groups with students and teachers and interviews with program coordinators. Data were transcribed verbatim and grouped according to data sources, coded, and analyzed thematically.
Results Themes identified from the focus group discussions and interviews were categorized as student, teacher, and environmental factors. Student factors include dependence on feedback, tendencies to use a group approach, difficulties recognizing social rules, a perceived lack of resilience, and tendencies to doubt praise. Factors related to teachers include a high level of expertise, being extremely busy, having a strong commitment, and being unsure of students’ acceptance of feedback. Clinical environment factors influence interactions between teachers and learners and include high power distance and collectivistic values. A safe environment is needed to ensure effective feedback interactions.
Conclusion High power distance, collectivism, and generational characteristics of students likely impact feedback practice in clinical settings. Designing a safe environment is essential for effective feedback practice.
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Purpose This study aims to verify whether the Reflective Practice Questionnaire (RPQ) developed by Priddis and Rogers is valid in the Korean context to identify the level of reflection of medical students in clinical practice.
Methods A total of 202 third- and fourth-year medical students from seven universities participated in the study. After receiving approval for use from the authors, a survey was conducted on the students through an adaptation process. The original scale consists of 10 factors with 40 items. The Self-efficacy in Clinical Performance Scale (SECP), Korean Self-reflection and Insight Scale (K-SRIS), and Reflection-in-Learning Scale (RinLS) were used to validate the scale. Exploratory factor, confirmatory factor, correlation, and reliability analyses were used for data analysis.
Results As a result of exploratory factor analysis, 10 subfactors were extracted (Kaiser-Meyer-Olkin=0.856, Bartlett’s test: χ 2 =5,044.337, degrees of freedom=780, p<0.001). Among the 40 items, one that showed a high overlapping load for other factors was excluded. As a result of confirmatory factor analysis, the 10-factor structure model was found suitable (χ 2 =1.980, comparative fit index=0.859, Tucker-Lewis index=0.841, root mean square error of approximation=0.070). As a result of the criterion validity test, most of the subfactors of the Korean version of the RPQ (K-RPQ) showed a positive correlation with K-SRIS, RinLS, and SECP. The reliability of 10 subfactors was satisfactory, ranging from 0.666 to 0.919.
Conclusion The K-RPQ was confirmed to be a reliable and valid tool to evaluate the level of reflection among Korean medical students in clinical clerkship. This scale can be used as a tool to provide feedback on each student’s level of reflection in clinical clerkship.
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Public health clinical rotation in the Faculty of Medicine, Universitas Islam Indonesia, was conducted in Puskesmas (community health center). This study aims to evaluate the public health clinical rotation in Puskesmas, part of the clinical clerkship of the Faculty of Medicine, Universitas Islam Indonesia. Several concerns have been highlighted regarding the implementation of clinical rotations in public health in Puskesmas. A briefing session before placement in the village must be coherent with a guidebook. The placement of students in the village was based on community health issues determined by the Puskesmas supervisor. Priority in the curriculum was given to converting the alertness village (Desa Siaga) into a Program Indonesia Sehat–Pendekatan Keluarga (Healthy Indonesia Program–Family Education) program throughout implementation. Moreover, scheduling after four major clinical programs was difficult, and the writing of reports served as a guide for establishing the correct format. Therefore, the objective of the evaluation was to assess knowledge, skill, and psychomotor, and the burden of assignment in Puskesmas was difficult to accomplish a primary task in the community.
Purpose Clinical rotations of medical students across the world have inevitably been affected due to the coronavirus disease 2019 (COVID-19) pandemic. The aims of this study were to explore medical students’ perception on the school’s response and management of clinical rotation during the COVID-19 pandemic and on how it had affected the quality of their education.
Methods An online questionnaire was distributed to third year medical students at one institution whose clinical rotations re-started during the pandemic. The questions asked about the students’ satisfaction with the school’s policy and feelings of safety, and the impact of COVID-19 on clinical learning.
Results The students’ perception on the school’s response to the pandemic was mixed. Re-commencement of the clinical rotations and procurement of personal protective equipment was positive but a third of students still felt unsafe. The decreased number of hospital patients did not seem to have impacted their overall clinical education with praise on the role of the supervising physicians. Seventy-six-point seven percent of students conferred the positive educational opportunities on medical professionalism presented to them only as the clinical rotation during the ongoing pandemic.
Conclusion Our observations on the re-commencement of clerkship during this pandemic may help equip medical institutions on future public health crisis.
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Purpose Medical students construct their identity as a student physician through clinical clerkship. However, there is a lack of research on the effect of clinical clerkship on professional self-concept formation. The aim of this study is to analyze and ascertain the relationship between medical students’ satisfaction with clinical clerkship and professional self-concept.
Methods This investigation studied 84 third- and fourth-year medical students enrolled in the Ajou University School of Medicine and Graduate School of Medicine. Study measures tools included satisfaction with clinical clerkship and professional self-concept measurement. For data analyses, a descriptive analysis of the research variable characteristics was applied, gender differences in variables by years of medical school were analyzed with t-tests, and correlation analysis was used to check for relationships between variables.
Results We found no statistically significant differences between satisfaction with clinical clerkship with respect to medical school year and gender. While professional self-concept did not show significant differences by year of medical school, we observed statistically significant differences by gender with respect to the subscales of professional practice and communication factor. In addition, satisfaction with clinical clerkship and professional self-concept demonstrated statistically significant positive correlation. The present research was able to confirm that there exists a correlation between medical students’ clinical clerkship experience and professional self-concept formation.
Conclusion Our study outcomes shows that provision of positive assistance as a measure to enhance satisfaction with clinical clerkship via the curriculum and environmental improvement is envisaged to lead to medical students’ professional self-concept formation.
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The purpose of this report was to describe our experience in planning and developing a portfolio for a clinical clerkship curriculum. We have developed a portfolio for assessing student competency since 2007. During an annual workshop on clinical clerkship curricula, clerkship directors from five Paik hospitals of Inje University met to improve the assessment of the portfolio. We generated templates for students to record their activities and reflection and receive feedback. We uploaded these templates to our school’s website for students to download freely. Annually, we have held a faculty development seminar and a workshop for portfolio assessment and feedback. Also, we established an orientation program on how to construct a learning portfolio for students. Future actions include creating a ubiquitous portfolio system, extending the portfolio to the entire curriculum, setting up an advisor system,
and managing the quality of the portfolio. This study could be helpful for medical schools that plan to improve their portfolio assessment with an outcome-based approach.
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Purpose Clinical performance examination (CPX) has been used to assess clinical competence as one step of medical license examination. Initial CPX score of the fourth year medical student is important since it indicates how to prepare successfully for the final examination. This study was conducted to assess the predictors of CPX scores of the fourth year medical students who completed core clinical clerkship.
Methods One hundred eleven fourth year medical students took a formative CPX in February. The score was compared with the scores of cognitive area and those of behavioral area which students had acquired in the past. We analyzed the correlation between the scores and determined the predictors of the fourth year CPX score.
Results The fourth year CPX score showed stronger correlation with the scores of behavioral area than those of cognitive area. The significant predictors of fourth year CPX score included third year simple procedure exam score and third year clerkship CPX score. The risk factors for low fourth year CPX score included second year patient-physician interaction (PPI) score and third year CPX score after adjusted for age, sex, and school type. The risk factors of being selected as a low PPI score group of fourth year included low PPI scores of first, second, and third year exams.
Conclusion Our study highlights importance of educational balance between cognitive and behavioral areas. To improve clinical competence of final year medical students, clinical interview training using standardized patient with other modules is to be enhanced and initiated early in the medical curriculum.
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PURPOSE This study examined the stress, resilience, social support, and quality of life (QOL) of medical students during a clinical clerkship and identified the factors that affected their QOL.
METHODS The subjects were 53 medical college students and 43 postgraduate medical school students of D medical school in Korea. They completed a demographic questionnaire and self-rated questionnaires on stress, resilience, social support, and QOL. Frequency and descriptive analysis, correlation analysis, and regression analysis were performed.
RESULTS The level of students' QOL was moderate. QOL correlated negatively with stress and positively with resilience and social support. Stress correlated negatively with resilience and social support. By regression analysis, stress and resilience affected the QOL of medical students.
CONCLUSION The results of this study indicate that stress negatively affects the QOL of medical students during clinical clerkship, which can be mitigated by resilience.
Therefore, it is advisable to develop measures to ease stress and enhance resilience.
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PURPOSE The aim of the study was to introduce our experience of establish task-based learning outcomes for core clinical clerkships.
METHODS We first define our educational goal and objective s of the clinical clerkship curriculum according to knowledge, cognitive function and skill, and attitude. We selected clinical presentations and related diseases with expert panels and allocated them to core clinical departments. We classified doctor's tasks into 6 categories: history taking, physical examination, diagnostic plan, therapeutic plan, acute and emergent management, and prevention and patient education. We described learning outcomes by task using behavioral terms.
RESULTS We established goals and objective s for students to achieve clinical competency on a primary care level. We selected 75 clinical presentations and described 377 learning outcomes.
CONCLUSION Our process can benefit medical schools that offer outcome-based medical education, especially for clinical clerkships. To drive effective clerkships, a supportive system including assessment and faculty development should be implemented.
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PURPOSE The purpose of this study was to investigate the teaching evaluation of clinical clerkship at Korean medical schools, and to suggest a desirable improvement for the clinical teaching evaluation in the future.
METHODS A questionnaire survey was conducted with a total of 9 multiple-choice questions and 1 essay-type question.
The multiple-choice questions were analyzed by the frequency analysis using SPSS 17.0, and the essay-type question was coded by the content analysis.
RESULTS Survey results were as follows: First, clinical teaching evaluations via online (51.35%) were implemented once a year (94.59%) in most medical schools. Second, the self-made questionnaires by medical school (64.86%) rather than borrowing or adaptation (35.14%) were being used more often as teaching evaluation tool. Third, 37.84% medical schools used the specific form by class type, whereas 62.16% medical schools took the general form regardless of class type. Finally, evaluation tool (n=8), lack of concern and attention to teaching evaluation (n=4), formalities of evaluation (n=4), etc. were exposed as problems of clinical teaching evaluation. With regard to evaluation items, the development of specific questions was required.
CONCLUSION Teaching evaluation can be used as effective educational tools to improve the clinical clerkship program.
To this end, clinical teaching evaluation tools reflecting the characteristics of clinical practice need to be developed.
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PURPOSE Although the importance of bedside teaching is generally recognized, there is no published report on the actual experience or effects of bedside teaching in Korea.
We aimed to study the effects and share the experience of bedside teaching during a clerkship in pulmonary medicine.
METHODS Bedside teaching was administered to 120 students through Year 3. To evaluate the improvement in clinical performance as a result of bedside teaching, students took the clinical performance examination (CPX) pre- and post-clerkship. They also completed a questionnaire about their perception of self-competence with regard to clinical performance. We analyzed the CPX scores and questionnaires.
RESULTS After introducing bedside teaching, CPX score on the pulmonary case increased from 48.9 to 60.1 between pre- and post-clerkship, respectively (p<0.001). Students had higher self-assessments of competency on the CPX, and their satisfaction with the clerkship increased.
CONCLUSION This study demonstrates that bedside teaching is effective in improving the clinical performance of medical students.
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PURPOSE The aims of this study were to define the necessity and effectiveness of patient safety education during surgical clerkship to develop competency for managing and preventing medical errors.
METHODS Fifty 3rd-year students participated in the patient safety education program during a 4-week surgical clerkship.
The students were divided into 4 groups: control group, pretest-only group, education-only group, and pretest and education group. Students were assessed using short essays and an oral exam for reasoning skills, clinical performance exams for patient education and communication skills, and multisource feedback and direct observation of error reporting for real-world problem-solving skills. The results were analyzed with SPSS 14.0K. The reliability (Cronbach alpha) of the entire assessment was 0.893.
RESULTS There was no difference in scores between early and late clerkship groups. Reasoning skills were improved by the pretest. Reasoning, patient education, and error reporting skills were much more developed by patient safety education.
Real-world error identification, reporting, and communication did not change after the 4-week course.
CONCLUSIONS Patient safety education during surgical clerkship is necessary and effective. Error prevention and competency management in the real world should developed.
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PURPOSE A proper patient-physician interaction (PPI) creates rapport between doctors and patients and improves medical outcomes. The importance of PPI evaluation items was evaluated in each medical student in grades 3 and 4, before and after their clinical clerkship.
METHODS Six PPI evaluation guidelines (SEGUE, Kalamazoo Consensus, Calgary-Cambridge Guide, Macy guideline, 2 Korean Consortium guidelines) were selected and importance of each guideline was evaluated through the structured questionnaire in 73 pre-clinical clerkship (3rd-grade) and 78 post-clinical clerkship (4th-grade) medical students.
RESULTS The importance of medical communication items among total clinical performance, students-rated PPI portion was 21+/-9.7%. In SEGUE recommendations, 'Elicit information' was evaluated to be most important items before (58.3%) and after (65.8%) clinical clerkship. In Kalamazoo Consensus, 'Gathering information' was evaluated to be most important (49.3%/42.3%), same as in Calgary-Cambridge Guide (52.1%/56.4%) and Daegu Gyeongbuk Consortium (47.9%/43.6%).
In the Macy guideline, 'Listening' was evaluated to be most important (28.8%/33.3%). In the Seoul Gyeonggi Consortium, 'Buidling relationships' was evaluated to be most important (23.3%/28.2%).
CONCLUSION In the 4th-grade post-clerkship medical students after clinical clerkship, importance of 'Gathering information' was evaluated to be less important, however, 'Giving information' and 'Understanding the patient perspective' was evaluated to be more important, compared to pre-clerkship students 3rd-grade students.
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PURPOSE This study aims to evaluate the effectiveness of a new teaching segment, named "problem-based clinical teaching," for the clinical clerkship in the undergraduate medical curriculum.
METHODS Students were given a problem weekly on a case that they had seen during their rotation. The problem was provided by the instructor from a case that had already been diagnosed but came up with an additional problem that called for further investigation by the attending physician. The task for the students was to conduct the investigation and discuss the problem with the attending physician. A survey was conducted of a class of 3rd year medical students (n=43) who completed clerkships in internal medicine to measure the level of student engagement in the problem-based clinical teaching segment and the students' overall perceptions of this new teaching method.
RESULTS Students generally agreed with the statements that they were actively engaged in the learning during the problem-based clinical teaching session. The students also perceived that this teaching session helped them acquire a deeper understanding of the knowledge and that it enhanced their problem solving skills and motivation.
CONCLUSION Problem-based clinical teaching is a useful educational method to apply problem-based learning in clinical clerkship settings.
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PURPOSE This study investigated the present conditions of clinical clerkship management in Korea to make recommendations for it.
METHODS The data were collected between April 15 and May 30 in 2009 using questionnaires that were sent to the clerkship directors of 41 colleges of medicine and medical graduate schools.
RESULTS The elective course system was established in 78% of the institutions; the 6 core specialties were found in all medical schools. The duration of clerkship was longest in internal medicine, followed by surgery, pediatrics, obstetrics and gynecology, psychiatry, and emergency medicine. There were differences between the planning and monitoring agencies. Preclinical courses existed in 92.7% of the institutions. However, much more remains to be done ie, with regard to the issues of student assessment in clinical clerkship, faculty development programs for the faculty and residents, incentive systems for educational involvement, provisions for yearly systematic clerkships, integration of basic-clinical science-medical humanities, and community-based education.
CONCLUSION Because clinical clerkship education is very important as a core curriculum, curriculum planning and its management must be given adequate attention. The following measures are suggested: elective systems that allow students to choose by career planning; concerns over faculty development programs for residents as a teacher; consensus on the concept, objective s, duration, content, evaluation tools of pre-clinical clerkship and clinical clerkship, and student well-being; and emphasis on community-based education.
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PURPOSE The aim of this study was to investigate correlations between medical student scores on 4 examinations: the written examination, clinical clerkship examination, clinical skill assessment, and graduation examination.
METHODS Scores for 51 students who entered Daegu Catholic Medical School in 2005 on the written examination, clinical clerkship examination, clinical skill assessment, and graduation examination were included. Correlations between the scores were analyzed statistically.
RESULTS The scores on the written examination showed a strong correlation with those of the clinical clerkship assessment (0.833) and graduation examination (0.821). The clinical clerkship assessment scores correlated significantly with graduation examination scores (0.907). In addition, clinical skill assessment scores correlated with the written examination (0.579), clinical clerkship examination (0.570), and graduation examination (0.465) scores.
CONCLUSION Overall, the correlation between the scores on the clinical clerkship examination and the written examination was more significant than the correlation between scores on the clinical clerkship examination and clinical skill assessment. Therefore, we need to improve the evaluation method for the clinical clerkship examination and clinical skill assessment.
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PURPOSE The purpose of this study was to identify the causal relationship between the following variables: basic science score, written examination score (Internal medicine and Pediatrics), clinical clerkship score (Internal medicine and Pediatrics), and affective factors (self-efficacy, anxiety, and perception of preparedness). METHODS: Forty-two medical students took the clinical performance examination (CPX) at the end of the first semester. One day before the CPX, the students completed a brief survey, which included 11 items that sampled their self-efficacy, preparedness and anxiety with regard to the CPX. The responses from the 38 identifiable surveys (90%), out of 42, were analyzed for this study. Structural equation modeling techniques were used to test the relationships between the variables. The students' basic science scores, clinical clerkship scores, and written examination scores were considered for this study. RESULTS: We found that self-efficacy influenced students' CPX scores indirectly through their preparedness and anxiety. Preparedness influenced students' CPX scores indirectly through their anxiety. Anxiety was predicated on self-efficacy directly or indirectly and it predicted CPX scores. The clinical clerkship scores affected the students' CPX scores indirectly. The written examination scores and basic science scores, however, did not impact the students' CPX scores directly or indirectly. The basic science scores, clinical clerkship scores, and written examination scores were not associated with self-efficacy. CONCLUSION: Our findings highlight the importance of clinical clerkship education and reasonable medical teaching methods in improving the student self-efficacy for the CPX.
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PURPOSE Despite the goal of medical education, which is 'training to be a primary care physician,' only written examinations (WEs) generally have been used to assess medical student ability. We assessed clinical competence using the CPX (clinical performance examination), PA (portfolio assessment), VMA (video-monitoring assessment), CGD (case group discussion), and PCP (primary clinical practice) during students' clerkships in family medicine and correlated these clinical assessment tools with WEs. Also, we correlated these tools with each other to determine the feasibility of each as a replacement of the other tools.
METHODS Thirty-nine fourth year students at University of Ulsan College of Medicine took part in their clerkship in family medicine for 2 weeks during the first session of 2005. They took 1 CPX, 2 VMAs, 6 CGDs, and 2 PCPs and were required to submit their portfolios at the end of the clerkship. We evaluated the correlations of these tools and WEs by the overall scores of each class year and in each subject.
RESULTS The CPX, VMA, and PCP showed no significant correlation,while PA showed strong correlation with 4th year students' overall WEs. The CGD showed strong correlation with all overall scores and with almost all subjects. In addition, the PA correlated significantly with CGD.
CONCLUSION New clinical assessment tools, such as CPX, PA, and VMA, have no significant correlation with WE, even though these tools closely correspond with real clinical practice. Therefore, these tools should be considered as complementary instruments to better assess clinical competence.
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PURPOSE The aim of this study is to identify the status of clerkship education and its evaluation in Korea.
METHODS Questionnaires were sent to 943personnel in 23clinical departments of 41medical schools nationwide from April, 1 to April 10, 2004. We analyzed the 638 questionnaires that were collected from 39medical schools.
RESULTS The most frequently used methodologies for clerkship education were small group lecture(17.1%), observation of ambulatory care(15.7%), seminar(12.9%), observation and support of operation(12.4%), ward rounding(12.1%). The relative proportion of educational methodologies was varied according to the type of clinical departments. Most of the clinical clerkship activity was conducted in the university hospital. Also, the clerkship activities were educated by professors(57.8%), fellows(9.1%), residents(30.6%) and others(2.5%). The evaluation methods were written exam(21.8%), attendance(17.5%), report(14.0%), and oral exam(12.0%). In terms of evaluating items, acquirement of clinical knowledge has been mainly tested. However, students' ability to communicate, build human relationship, and clinical skills has been less frequently evaluated in most of medical schools.
CONCLUSION It is most likely that the current status of clerkship education and its evaluation in Korea is focused on the education and assessment of clinical knowledge. To improve this, the following areas need to be enriched: interaction between faculty and students, experience-based clerkship, effective feedback, time management, objectivity of evaluation, performance evaluation.
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PURPOSE The purpose of this study is to find a strategy for reintroducing the core-selective clinical clerkship system to the Seoul National University College of Medicine's clerkship curriculum, which has an unsuccessful history with this system ('86-'90). METHODS: Authors conducted a literature review to identify problems recognized from the past experience and a focus group interview with related personnel to prioritize the problems. From 5 domains of problems identified, interviewees focused on 2 problems- problems in the definition of 'what are the core (compulsory) and the selective (optional) rotations' and the tendency of students to crowd in popular subjects.
Therefore, to redetermine what is core clerkship subjects and to predict the selection tendency of students, we conducted questionnaire surveys from students (N=171), residents (N=84), and practitioners (N=78). As for should-be core clerkship rotations, students and residents included radiology and neurology and practitioners included emergency medicine, radiology and orthopedics. We concluded that these 4 rotations should be added to the predetermined 5 core rotations (internal medicine, general surgery, pediatrics, obstetrics & gynecology, and psychiatrics). Students selection ratio varied from very high (69%) to very low (32%), and selected rotations by individual students showed statistically significant correlations. The students were classified, according to rotation selection tendency, into 4 clusters. RESULTS: As for should-be core clerkship rotations, students and residents included radiology and neurology and practitioners included emergency medicine, radiology and orthopedics. We concluded that these 4 rotations should be added to the predetermined 5 core rotations (internal medicine, general surgery, pediatrics, obstetrics & gynecology, and psychiatrics). Students selection ratio varied from very high (69%) to very low (32%), and selected rotations by individual students showed statistically significant correlations. The students were classified, according to rotation selection tendency, into 4 clusters. CONCLUSION: Integrating the analysis of the selection ratio and that of selection tendency of individual students, we built a scenario that could prevent the crowding of students in popular specialty clerkships, and at the same time, could avoid neglecting students right to select rotations that interest them.
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PURPOSE The purpose of this study was to present the results of a clerkship evaluation done through a student questionnaire, to provide appropriate feedback to faculty, and to make constructive suggestions for improving the educational experience during clerkship. METHODS: The evaluation was conducted in 2003 at The College of Medicine at Catholic University. 61 fourth-year medical students who had finished their clerkship rotations completed the given questionnaire. This questionnaire was composed of items covering 8 dimensions related to: overall assessment of the clerkship, problems in clerkship contents and methods, the evaluation process, the best preceptor and the characteristics of the vest clinical faculty, the most useful educational activities and constraining activities, and areas th be improved. RESULTS: Most of the students gave a negative evaluation to the overall clerkship. The most serious problem were the high number of activities irrelevant to the clerkship and the lack of opportunity for direct participation. The most useful educational activities were: 1) case presentation on for assigned patients, 2) 'mini lectures' provided during ward rounds, 3) assigned patient care as a team, and 4) performing clinical skills under faculty supervision. The most constraining activities were: 1) difficulty interacting with patients as a student, 2) inefficient time management, and 3) unsystematic clinical clerkship schedule. CONCLUSION: In conclusion, the most fundamental problem in clinical teaching was the lack of support and incentives for clinical teachers. Not only training sessions for faculty and residents but also financial rewards or promotion opportunities need to be provided for a better quality clinical clerkship.
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PURPOSE To know the current status and to improve the internal medicine clinical clerkship in one medical school, the author performed a mid-term survey of the students.
METHODS Questions were given to 48 students at the midpoint of their internal medicine clinical clerkship. Questions were about understanding the of purpose of the rotation, ability to do physical examination and procedures, bedside teaching experience and conferences, and support during clinical clerkship. Questions used 5-point Likert scale. 48 of 48 students responded. Average points for each question were calculated, and similar free answers were categorized together. RESULTS: Students began their clinical clerkship with high expectations, but soon fell into a 'busy but know-nothing' state. The purpose of the clinical clerkship was not clearly outlined. Students learned physical examination skills and procedures not directly from instructors but by watching over-the-shoulder. Bedside teaching was, in fact, 'table side' teaching. Instructors did not provide immediate feedback at the bedside on how the student gathered information from patients, Students attended conferences targeted towards residents, and they could not understand the ensuing discussions. Students had no sense of belonging to the ward team. This result was reported during a medical grand round with simple short-term strategies, which could be performed easily, and with longer-term strategies requiring more resources. CONCLUSION: The author did a mid-term survey of a clinical clerkship and reported the result with suggested strategies for improvement. The result was distributed to the faculty at other departments as well. Although there was resistance to the suggestions from the internal medicine department, this report was used to initiate clinical clerkship improvement to the clerkship in other departments. The author discusses this result along with a literature review. This paper can be a good resource for medical schools wanting to evaluate and improve their clinical clerkship.
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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.
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PURPOSE To report the experience of OSCE performed as a summative assessment of the medical students in year 4 at Ewha Womans University. METHODS: Ninety-eight students took the twenty stations including 3 pairs of linked stations. We conducted duplicated OSCEs and each station runs 4 minutes 30 seconds. We analyzed the validity of stations, the reliability of duplicated OSCEs and the difference of scores according to the OSCE tools and categories. RESULTS: Mean OSCE score was 64.45+/-5.49 and Cronbach-alpha of total stations was 0.74. The scores between duplicated examinee groups and between duplicated evaluator groups were not different: the score of preceding examinee group was 63.3 and the later 65.7 (p=0.13), and the score of the first evaluator group was 64.6 and the second was 63.6 (p=0.16).
However according to the individual analysis, 9 stations showed statistically discrepancies (p< 0.05) between duplicated evaluator groups. Regarding OSCE tools and categories, physical examination and skill categories did not show statistically significant differences between duplicated evaluator groups. OSCE scores showed moderate correlation with the cummulative performance grade in general (r=0.53, p< 0.01). CONCLUSIONs: OSCE could be regarded as a reasonable evaluating tool for the summative assessment after two years of clinical clerkship of the fourth year medical students. Analysis of the OSCE stations which was done individually and according to OSCE tools/categories helps to improve the OSCE more complete and the duplicated stations more coincident.
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Developing a best practice framework for clinical competency education in the traditional East-Asian medicine curriculum Sang Yun Han, Seung-Hee Lee, Han Chae BMC Medical Education.2022;[Epub] CrossRef
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Correlations of Clinical Assessment Tools with Written Examinations Eun Jeong Choi, Sung Sunwoo Korean Journal of Medical Education.2009; 21(1): 43. CrossRef
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PURPOSE Observation of operations is believed to be a major part in the clinical clerkship of surgery, but it is very hard to be performed effectively due to the difficulty of providing an appropriate view of surgical field for many students. To overcome this problem, we have started to provide a tele-video system for clinical clerkship of surgery since 2001. The aim of this study was to evaluate the effectiveness of educational program of surgery using tele-video system. METHODS: We provided the tele-video system with camera systems in two operating rooms and 2 video projection systems in the teaching room to the third year medical students as a curriculum of clinical clerkship of surgery. Education using tele-video system was performed in the form of the interrogatory teaching between the teacher (operator) and students using microphone. The questionnaires about the program of clinical clerkship of surgery and the education with tele-video system were filled up by 190 students who had completed the 4 weeks clerkship schedule. After then, items in the questionnaires were analyzed in September and in December to evaluate the change of the students' response for the education with tele-video system. RESULTS: Eighty-eight percent of students had experienced the education with tele-video system. Most students (96%) recommended this system to their juniors, and 78% of students wanted this system to be also used in other departments' clinical clerkship. The advantages of tele-video system were revealed as the better view of surgical field, followed by clear explanation for the surgical procedure, interrogatory teaching between the operator and the students, and so on. The most effective teaching methods were revealed as direct participating in the operation (33%), followed by tele-video system (32%), reading of textbook (19%), and simple observation of the operation (15%). General satisfaction for tele-video system were scored with five (11%), four (48%), three (25%), two (7%), and one (1%) (5=excellent, 1=very poor). General satisfaction rate about tele-video system was markedly improved from September to December. CONCLUSIONS: The education with tele-video system in the clinical clerkship of surgery seems to be very effective method for teaching the medical students.
PURPOSE The aims of this paper are to develop a student evaluation format as a part of core clinical clerkship (student internship) program at Gachon Medical School, and to identify its impeding factors in implementation. METHODS: Both rating scale of Likert type and check list for student's clerkship assessment were designed; the rating scale format was developed into two parts, namely attendance and the clinical competence demonstrated during the clerkship in which 3 domains of knowledge, skills and attitude were included in balance; the professional competence was made of 9 items, each being designed to accommodate 3 degrees by learner's performance. The clinical instructors in charge were requested to sit a short feedback session on the evaluation results with students who were signed at the end. Nursing staff was also asked to participate in evaluation of the student attitude in a limited area. RESULTS: Despite the full acceptance of the evaluation approach theoretically, its practical implementation was not successful because of difficulties related to adjustment of their department-based scoring system to the comprehensive assessment, or unfamiliarity with face-to-face feedback system. CONCLUSION: The authors assume that this Likert type of the rating scale is a simple, more comprehensive and strong tool to meet the learning objective s, and easy to enhance the feedback effect. It is, however, advised that the formative reporting system is crucial to transform the traditional evaluation approach into the pass/fail format so that unnecessary conversion risk is eliminated.
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Status of Clerkship Education and Its Evaluation in Korean Medical Schools Eunbae Yang, Duk-Joon Suh, Yunseong Lee, Sookon Lee, Seokhwa Kim, Eunil Lee, Guetae Chae, Yeonju Jo, Ducksun Ahn Korean Journal of Medical Education.2007; 19(2): 111. CrossRef
PURPOSE Clinical teaching is at the center of medical education. To improve the quality of clerkship education, regular and structured program assessment is essential. The purpose of this study were to: 1) evaluate the effectiveness of the clerkship program at The College of Medicine at Korea University, 2000-2001, 2) to provide feedback to faculty, and 3) to improve the quality of clinical education.
METHODS The subjects of this study were the fourth year medical students who had finished all the clerkship rotation. The questionnaire consisted of items covering 6 potential dimensions considered relevant to the educational quality of clerkship. The dimensions consisted of aspects related to: clerkship contents and curriculum, evaluation, helpful vs. least helpful educational activity, the characteristics of best and worst clinical teachers and the student's self assessment for clinical competency.
RESULTS Most of students evaluated overall clerkship course contents and structure as negatively. Most helpful preceptor was revealed as residents. The characteristics of best clinical teacher were: 1) careful consideration and humanistic approach for students, 2) role modelling of good physician, 3) organized and systematic teaching, 4) enthusiam for teaching, 5) effective communication with either students or residents.
CONCLUSION The results could be used for faculty development and improving the quality of clerkship course by feedback to program director. Also, this result suggested that teaching resident to teach is need to effective clinical teaching.
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Evaluating Methods of Reinforcing the Clinical Clerkship Son-Hwan Choi, Han-Byul Jung Korean Medical Education Review.2015; 17(3): 122. CrossRef
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If medical campus is composed of multi-campus, the standardization of the students' clinical clerkship is one of the major concerns in medical education, since it is very difficult to supervise the precise students' performances by the executive officers. To improve and to standardize the clinical clerkship, the objective structured clinical examination and the clinical skill test was done and its results were analyzed. On February 11, 2001, the 85 junior students of the College of Medicine, Hallym University, undertook the examinations with 10 items. Mean of the results was 72.73. There was no significant difference of scores according to sex, and group of examinees. There was significant difference according to the hospital of students' clerkship in spite of there was no significant difference of the scores of written examination and total score of clinical clerkship. There was a significant difference of experiences of clinical skills according to the hospital. There was a positive correlation between degree of experience of clinical skills and scores (r=0.3888). The most important factor influencing the scores is believed to be a experience of clinical skills in the hospital since it can be postulated that the students' ability was not different according to the hospital. Also the depth of the clinical skill was also may be another influencing factor to the scores. When students works in multi-campus hospitals, the professors or educational supervisors should check the clinical skills as the guideline indicated, for the standardization of the clinical clerkship.
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