Purpose This study evaluated the underlying subdomain structure of the Self-Directed Learning Readiness Scale (SDLRS) for medical students and refined the instrument to measure the subdomains to provide evidence for construct validity. Developing self-directed learners is a well-recognized goal amongst medical educators. The SDLRS has been frequently used, however, lack of construct validity makes it difficult to interpret results.
Methods To identify the valid subdomains of the SDLRS, items were calibrated with the graded response model (GRM) and results were used to construct a 30-item short form. Short-form validity was evaluated by examining the correspondence between the total scores from the short form and the original instrument for individual students.
Results A five-subdomain model explained the SDLRS item response data reasonably well. These included: (1) initiative and independence in learning, (2) self-concept as an effective learner, (3) openness to learning opportunity, (4) love of learning, and (5) acceptance for one’s own learning. The unidimensional GRM for each subdomain fits the data better than multi-dimensional models. The total scores from the refined short form and the original form were correlated at 0.98 and the mean difference was 1.33, providing evidence for validation. Nearly 91% of 179 respondents were accurately classified within the low, average, and high readiness groups.
Conclusion Sufficient evidence was obtained for the validity and reliability of the refined 30-item short-form targeting five subdomains to measure medical students’ readiness to engage in self-directed learning.
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Purpose Residents’ gender, residency level, and hospital types might influence their attitudes towards clinical supervision (CS); however, reports of its impact on cardiology residency are nonexistent. We explore the effect of gender, residency level, and hospital location’s effect on Indonesian cardiology trainees’ attitudes towards CS.
Methods A multi-centered, cross-sectional study was conducted. We invited 490 Indonesian cardiology residents in September– October 2019 to complete the Cardiology CS Scale. Residents’ attitudes, gender, university, and residency year were expressed using descriptive statistics. A Mann-Whitney test analyzed the gender and university location effect on residents’ attitudes. Training year and university’s impact were subjected to the Kruskal-Wallis test; a p-value of <0.05 reflected a significant result.
Results A total of 388 residents agreed to participate (response rate=79.18%). Most of them were male (n=229 [59,02%]), attended universities in Java Island (n=262 [67,52%]), and were in their 2nd–3rd year of training (n=95 [24.48%], each). There were no significant differences in residents’ attitudes between genders (U [Nmale=229, Nfemale=159]=17,908.50, z=-0.27, p=0.78). Generally, their attitudes were significantly affected by the university (H(7)=47.38, p<0.01). However, the university location (located in Java Island or outside Java Island) does not affect residents’ attitude towards CS (U [NJava=262, Nnon-Java=126]=15,237.00, z=-1.23, p=0.22). In addition, the residents’ training year also affected the residents’ response (H(2)=14.278, p<0.01).
Conclusion Cardiology residents’ attitudes towards CS are significantly influenced by training year and university but not gender or university location. The results might provide insightful information for further improvement of CS in cardiology training and guide further evaluation.
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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Purpose The purpose of this study is to determine whether there is any change in the empathy scores of third-year medical graduate students after they have taken a clerkship and have begun gaining more opportunities to meet patients through the clerkship.
Methods The participants were 109 third-year students in 2014 and 110 fourth-year students in 2015 at Kyungpook National University, School of Medicine. The author measured empathy using a modified and expanded version of the Korean version of the Jefferson Scale of Empathy of Physician Empathy-Student version and used the Holland-III aptitude test-S to assess vocational aptitude.
Results As a results, male students in their third year exhibited higher scores, but there was no significant difference in the fourth year. The empathy score increased slightly when third-year students became fourth-year students, but the difference was not statistically significant. There was no statistically significant change in the scores of both male and female students between the 2 years. The results of the vocational aptitude test showed that students who preferred person-oriented specialties had higher empathy scores when they entered their fourth academic year compared to objective ly-oriented students.
Conclusion In this study, male students showed higher empathy scores than female students, an atypical finding that was inconsistent with the results of previous studies. However, the distribution of scores among male students was wider than that of female students, a finding consistent with previous studies. As such, individual differences need to be considered when developing curriculum in order to improve the empathy of medical students.
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Purpose Recent studies have emphasized the importance of empathy in the physician-patient relationship (PPR). The purpose of this study was to examine the association between empathy scores, as measured by the student version of the Jefferson Scale
of Empathy, Korean edition (JSE-S-K), and PPR scores on the clinical performance examination (CPX).
Methods The sample comprised 104 third-year medical students. Prior to undertaking 12 cases on the CPX, the students completed the JSE-S-K and Myers-Briggs Type Indicator. We analyzed the differences in empathy and PPR scores according to their sociodemographic characteristics and personality types and verified the link between empathy and PPR scores by stepwise multiple linear regression analysis.
Results PPR scores were positively associated with total JSE-S-K scores (r=0.232, p<0.05) and its affective domain scores (r=0.229, p<0.05). Education program (undergraduate or graduate entry) and empathy score were the best predictors of PPR score (R2=0.153).
Conclusion The positive association between empathy and PPR scores suggests that empathy is an important factor that influences the PPR.
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Purpose Medical students experience various stresses that arise in a special environment. However, there is no specific stress scale for medical students with regard to their environment in Korea. Therefore, in this study, we developed and confirmed the validity of a stress scale for medical students in Korea.
Methods A draft version of the scale was developed on the basis of open-ended questionnaires from 97 medical students. The validity of the content of this scale was evaluated by three medical educationists. The scale was administered to 435 third and fourth grade medical students as the main survey. For our data, we performed an exploratory factor analysis and confirmatory factor analysis. We used Cronbach α index to determine internal consistency.
Results Six factors with 40 items were extracted through the exploratory factor analysis: academic stress (9 items); clerkship stress (11 items); interpersonal stress (7 items); career stress (8 items); health-related stress (3 items); and financial stress (2 items). These factors showed a statistically significant correlation. The confirmatory factor analysis demonstrated a favorable RMSEA (0.053) and reasonable fit (CFI=0.847, TLI=0.833). Cronbach α values of the six factors ranged from 0.63 to 0.85.
Conclusion The medical student stress scale had a good model fit. It is a valid and reliable instrument in identifying stress in medical students and can be used in future studies. Also, the scale is expected to provide individual stress profiles for students to help them manage stress more effectively.
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Methods In 2006 and 2009, 236 fourth-year medial students of C College of Medicine took the Patient Practitioner Orientation Scale (PPOS) by Krupet et al. (2000), which measures patient-centered attitudes in patient-physician relationships. The data were analyzed by independent t-test and two-way analysis of variance using SPSS 21.0.
Results The PPOS scores of year 2006 students were 3.88±0.25 for males and 3.98±0.38 for females. For year 2009 students, males scored 3.81±0.42 and females scored 4.01±0.48. All students had higher Care scores than Share scores (2006: Share, 3.67±0.47 vs. Care, 4.19±0.51; 2009: Share, 3.56±0.34 vs. Care, 4.18±0.53). There were significant differences in PPOS and Share scores by gender before and after the CPX. With regard to Care scores, female students' scores tended to rise and males' scores declined over time.
Conclusion An educational program is needed for students to foster patient-centered attitudes, but gender differences should be taken into account.
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PURPOSE From the point of view that medical students are under the pressure of academic achievement and vulnerable to subjective distress, there is need for evaluate their strategies for enhancing self-esteem when they failed academically. This study was to develop the scale for enhancing self-esteem and to confirm the convergent, discriminant and criteria validity.
METHODS Data were collected from 279 students at a medical school in Seoul. The scale of strategies for enhancing self-esteem (SSES) comprised comparison with inferior, doubting academic failure, accepting failure, and attribution to incidental factors. Also, to confirm the validities, participants responded to items measuring self-esteem, narcissism, 5 personality factors, depression and adjustment.
RESULTS By explanatory factor analysis of SSES, composed of three factors-comparison, doubting, and acceptance-and in the confirmatory factor analysis, 3 dimensions were best fit. Notably, comparison and doubting strategies were positively associated with depression and negatively associated with adjustment. In contrast, acceptance strategies were negatively associated with depression and positively associated with adjustment. Additionally, comparison and doubting strategies were positively associated with narcissism.
CONCLUSION The SSES of medical school students after academic failure yields 3 dimensions reliably and consistently. Also, it shows satisfactory convergent and concurrent validities.
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PURPOSE To identify predictors of medical students' beliefs about intelligence among affective and cognitive factors, parental interest in children's education, and home economic status (HES). Of the 408 medical students who participated in this study, 398 completed and returned the questionnaires, yielding a total response rate of 97.5%.
METHODS Measures of students' beliefs about intelligence, intrinsic value, self-efficacy, test anxiety, cognitive strategies, self-regulation, parental interest in children's education, and HES were obtained. RESULTS: Spearman's correlations indicated that an entity theory of intelligence was negatively related to intrinsic value, self-efficacy, cognitive strategies, self-regulation, parental interest in children's education, and HES, and positively related to test anxiety. An incremental theory of intelligence was positively related to intrinsic value, self-efficacy, cognitive strategies, self-regulation, parental interest in children's education, and HES, and negatively related to test anxiety. Findings of independent t-tests showed that incremental theorists showed higher intrinsic value, self-efficacy, cognitive strategies, self-regulation, parental interest in children's education, and lower test anxiety than entity theorists. A binary logistic regression analysis showed that 72.9% of the medical students in the study were accurately classified as either incremental theorists or entity theorists with respect to intrinsic value, self-efficacy, test anxiety, and cognitive strategies. CONCLUSION: Medical educators need to be aware that medical students who have incremental beliefs about intelligence have higher intrinsic value, self-efficacy, cognitive strategies, and lower test anxiety than those who have fixed beliefs about intelligence. Perhaps a training program needs to be developed to enhance medical students' conceptions of intelligence based on the findings.
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PURPOSE Senior medical students agreed to undergo gastrofibroscopy testing in the same manner as patients would in order to assess if the experience affects their understanding of patients' discomfort and their recommendation of this test.
METHODS 27 senior medical students rotating through family medicine underwent gastrofiberscopy. The level of discomfort experienced by these students was evaluated by using the Visual Analogue Scale(VAS). Each student's recommendation of gastrofibroscopy or upper gastrointestinal series to asymptomatic and symptomatic adults with upper GI complaint was recorded. And we assessed the need of patient experience for recommendation of gastrofibroscopy.
RESULTS Before having experienced a gastrofibroscopy, 21 students recommended gastrofibroscopy (21 cases, 77.8%) and 6 recommended upper gastrointestinal series(6 cases, 22.2%) as screening tests in asymptomatic adults. After having had a gastrofibroscopy, gastrofibroscopy was recommended in 16 cases(59.3%) and the upper gastrointestinal series in 11(40.7%), again in asymptomatic adults. However in symptomatic adults, there was no change. The degree of discomfort after having had a gastroscopy was less than they thought(5 cases, 18.5%), the same (5 cases, 18.5%), and more than they thought(17 cases, 63.0%), 25(92.5%) students thought experiencing gastrofibroscopy would help them explain the procedure to patients in the future. 26(96.3%) students expressed that doctors who recommend gastrofibroscopies should experience having the test so that they can better empatize and understand patients' discomfort.
CONCLUSION Senior medical students' experience being a patient is a significant learning opportunity for understanding the patient discomfort. This experience will help doctors understand patient's discomfort.
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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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