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  • 1
    Online Resource
    Online Resource
    Sustained effects of faculty leadership development modules for clinical instructors of core competences education in Taiwan: a four-year explanatory case study
    Springer Science and Business Media LLC ; 2020
    In:  BMC Medical Education Vol. 20, No. 1 ( 2020-12)
    Details
    In: BMC Medical Education, Springer Science and Business Media LLC, Vol. 20, No. 1 ( 2020-12)
    Abstract: The Accreditation Council for Graduate Medical Education (ACGME) core competencies (CC) in general medicine-based primary care are essential for junior medical trainees. In this country, a regular faculty development (FD) program aimed at training faculty in instructing (teaching and assessing) these CC had operated. However, leadership was not emphasized. In a new intervention module, the roles and associated responsibilities of clinical instructors to conduct , design , and lead CC-based education were emphasis. Aims This follow-up explanatory case study compares the effectiveness of intervention module with that of the previous regular module. Methods The regular group ( n  = 28) comprised clinical instructors who participated in the FD module during the 2013–2014 year while the intervention group ( n  = 28) was composed of 2015–2016 participants. Prior to the formal ( hands-on ) training, participants in the intervention group were asked to study the online materials of the regular module. These participants then received a 30-h hands-on training in conducting , designing , and leading skills. Finally, they prepared a 10-h reflective end-of-module presentation of their real-world practices. Results Following the training, a higher degree improvement in participants self-reported familiarity with CC education, self-confidence in their ability to deliver CC education and sustained involve CC education were noted among the intervention FD group, compared with the regular FD group. In the intervention group, senior academicians (associate and full professor) are more substantially involved in designing and leading CC-based courses than junior academicians (lecturers and assistant professors). Among non-teaching award winners of in the intervention FD group, the follow-up degree of sustained involvement in delivering, designing and leading CC-based courses was significantly higher than that of the regular group. Conclusions Our study demonstrated that leadership training in the intervention FD modules substantially motivated clinical instructors to become leaders in CC education.
    Type of Medium: Online Resource
    ISSN: 1472-6920
    URL: Article
    DOI: 10.1186/s12909-020-02065-w
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2044473-4
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  • 2
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    Enhancing the learning and transfer of preprocedural communication skills during clerkship using audio-visual material: a prospective case-controlled study over 2 years
    BMJ ; 2022
    In:  BMJ Open Vol. 12, No. 1 ( 2022-01), p. e055953-
    Details
    In: BMJ Open, BMJ, Vol. 12, No. 1 ( 2022-01), p. e055953-
    Abstract: This study aims to develop preprocedural communication-specific framework that emphasises the use of audiovisual materials and compares its acceptability by trainees with a regular module. Trainees Between October 2018 and July 2021, 96 medical clerks were enrolled and randomly divided into regular and intervention groups. Another 48 trainees whose did not join the framework-based training but complete self-assessments were enrolled as the control group. Interventions In the intervention training module, the key steps of preprocedural communication-specific skills were structuralised into a framework using the acronym of OSCAR. Primary and secondary outcome measures This study compared the acceptability of trainees for two modules by measuring the degree of increase in the end-of-rotation and follow up (4 weeks later) competency from baseline by trainees’ self-assessments and physician assessments after serial trainings. Results In comparison with regular group trainees, greater degree of improvements (framework-1 statement: 111%±13% vs 27%±5%, p 〈 0.001; framework-2 statement: 77%±9% vs 48%±2%, p 〈 0.05; skill-1 statement: 105%±9% vs 48%±3%, p 〈 0.001); skill-2 statement: 71%±11% vs 50%±9%, p 〈 0.05) were noted in the framework-related and skill-related statement 1–2 (the familiarity and confidence to use the framework and skills) than those of intervention group. At the end-of-rotation stage, the trainees ability to use the ‘ A -step: using audiovisual materials’ of the OSCAR was significantly improved (229%±13%, p 〈 0.001), compared with other steps. In the intervention group, the degree of improvement of the end-of-rotation data of trainees’ self-assessment from baseline was significantly correlated with the degree of the improvement in physicians’ assessment data in the aspects of skills, framework and steps in framework (R=0.872, p 〈 0.01; R=0.813, p 〈 0.001; R=0.914, p 〈 0.001). Conclusions The OSCAR framework-based intervention module is well accepted by medical clerks and motivates them to integrate the acquired skills in clinical practice, which leads to trainees’ primary care patients being satisfied with their preprocedural communication.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2021-055953
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 2599832-8
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  • 3
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    Standard setting made easy: validating the Equal Z-score (EZ) method for setting cut-score for clinical examinations
    Springer Science and Business Media LLC ; 2020
    In:  BMC Medical Education Vol. 20, No. 1 ( 2020-12)
    Details
    In: BMC Medical Education, Springer Science and Business Media LLC, Vol. 20, No. 1 ( 2020-12)
    Abstract: This study aims to assess the feasibility, reliability and validity of the panel-based Equal Z-score (EZ) method applied to objective structural clinical examination (OSCE) of Chinese medical students and undertaking a comparison with the statistical techniques-based Borderline Regression Method (BRM). Methods Data received from two cohorts of 6th and 7th year medical students in Taiwan who set the mock OSCE as a formative assessment. Traditionally this medical school uses BRM to set the pass/fail cut-score. For the current study, 31 OSCE panellists volunteered to participate in the EZ method in parallel to the BRM. Results In the conduct of this study, each panel completed this task for an OSCE exam comprising 12 stations within less than 60 min. Moreover, none of the 31 panellists, whose are busy clinicians, had indicated that the task was too difficult or too time-consuming. Although EZ method yielded higher cut-scores than the BRM it was found reliable. Intraclass correlation (ICC) measuring absolute agreement, across the three groups of panellists was .893 and .937 for the first and second rounds respectively, demonstrating high level of agreement across groups with the EZ method and the alignment between the BRM and the EZ method was visually observed. The paired t-test results identified smaller differences between the cut-scores within methods than across methods. Conclusions Overall this study suggests that the EZ method is a feasible, reliable and valid standard setting method. The EZ method requires relatively little resources (takes about an hour to assess a 12 station OSCE); the calculation of the cut-score is simple and requires basic statistical skills; it is highly reliable even when only 10 panellists participate in the process; and its validity is supported by comparison to BRM. This study suggests that the EZ method is a feasible, reliable and valid standard setting method.
    Type of Medium: Online Resource
    ISSN: 1472-6920
    URL: Article
    DOI: 10.1186/s12909-020-02080-x
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2044473-4
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  • 4
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    Immersive virtual reality (VR) training increases the self-efficacy of in-hospital healthcare providers and patient families regarding tracheostomy-related knowledge and care skills : A prospective pre–post study
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Medicine Vol. 101, No. 2 ( 2022-01-14), p. e28570-
    Details
    In: Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 101, No. 2 ( 2022-01-14), p. e28570-
    Type of Medium: Online Resource
    ISSN: 0025-7974 , 1536-5964
    URL: Article
    DOI: 10.1097/MD.0000000000028570
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2049818-4
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  • 5
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    Medical school grades may predict future clinical competence
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Journal of the Chinese Medical Association Vol. 85, No. 9 ( 2022-09), p. 909-914
    Details
    In: Journal of the Chinese Medical Association, Ovid Technologies (Wolters Kluwer Health), Vol. 85, No. 9 ( 2022-09), p. 909-914
    Abstract: In real-world medical education, there is a lack of reliable predictors of future clinical competencies. Hence, we aim to identify the factors associated with clinical competencies and construct a prediction model to identify “improvement required” trainees. Methods: We analyzed data from medical students who graduated from National Yang-Ming University with clerkship training and participated in the postgraduate year (PGY) interview at Taipei Veterans General Hospital. Clinical competencies were evaluated using grades of national objective structured clinical examination (OSCEs). This study used data from medical students who graduated in July 2018 as the derivation cohort (N = 50) and those who graduated in July 2020 (n = 56) for validation. Results: Medical school grades were associated with the performance of national OSCEs (Pearson r = 0.34, p = 0.017), but the grades of the structured PGY interviews were marginally associated with the national OSCE (Pearson r = 0.268, p = 0.06). A prediction model was constructed to identify “improvement required” trainees, defined: trainees with the lowest 25% of scores in the national OSCEs. According to this model, trainees with the lowest 25% medical school grades predicted a higher risk of the “improvement required” clinical performance (Q1–Q3 vs Q4 = 15% vs 60%, odds ratio = 8.5 [95% confidence interval = 1.8-39.4], p = 0.029). In the validation cohort, our prediction model could accurately classify 76.7% “improvement required” and “nonimprovement required” students. Conclusion: Our study suggests that interventions for students with unsatisfactory medical school grades are warranted to improve their clinical competencies.
    Type of Medium: Online Resource
    ISSN: 1726-4901
    URL: Article
    DOI: 10.1097/JCMA.0000000000000782
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2202774-9
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  • 6
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    Comparison of OSCE performance between 6- and 7-year medical school curricula in Taiwan
    Springer Science and Business Media LLC ; 2022
    In:  BMC Medical Education Vol. 22, No. 1 ( 2022-12)
    Details
    In: BMC Medical Education, Springer Science and Business Media LLC, Vol. 22, No. 1 ( 2022-12)
    Abstract: The year 2013 marks a watershed in the history of medical education in Taiwan. Following Taiwan’s Taskforce of Medical School Curriculum Reform recommendations, the medical school curriculum was reduced from 7 to 6 years. This study aimed to analyze the impact of medical school curriculum reform on medical students’ performance in objective structured clinical examinations (OSCEs). Methods We retrospectively analyzed the OSCE records at Taipei Veterans General Hospital (Taipei VGH), one of Taiwan’s largest tertiary medical centers, between November 2016 and July 2020. The eligibility criteria were medical students receiving a full one-year clinical sub-internship training at Taipei VGH and in their last year of medical school. All medical students received a mock OSCE-1 at the beginning of their sub-internship, a mock OSCE-2 after six months of training, and a national OSCE at the end of their sub-internship. The parameters for performance in OSCEs included “percentage of scores above the qualification standard” and “percentage of qualified stations.” Results Between November 2016 and July 2020, 361 undergraduates underwent clinical sub-internship training at Taipei VGH. Among them, 218 were taught under the 7-year curriculum, and 143 were instructed under the 6-year curriculum. Based on baseline-adjusted ANCOVA results, medical students under the 7-year curriculum had a higher percentage of scores above the qualification standard than those under the 6-year curriculum at the mock OSCE-1 (7-year curriculum vs. 6-year curriculum: 33.8% [95% CI 32.0–35.7] vs. 28.2% [95% CI 25.9–30.4] , p   〈  0.001), and mock OSCE-2 (7-year curriculum vs. 6-year curriculum: 89.4% [95% CI 87.4–91.4] vs. 84.0% [95% CI 81.5–86.4] , p  = 0.001). Moreover, medical students in the 7-year curriculum had a higher percentage of qualified stations in mock OSCE-1 (7-year curriculum vs. 6-year curriculum: 89.4% [95% CI 87.4–91.4] vs. 84.0% [95% CI 81.5–86.4] , p  = 0.001) and mock OSCE-2 (7-year curriculum vs. 6-year curriculum: 91.9% [95% CI 90.1–93.8] vs. 86.1% [95% CI 83.8–88.3] , p = 0.001). After clinical sub-internship training, there were no differences in the percentage of scores above the qualification standard (7-year curriculum vs. 6-year curriculum: 33.5% [95% CI 32.2–34.9] vs. 34.6 [95% CI 32.9–36.3] , p  = 0.328) and percentage of qualified stations (7-year curriculum vs. 6-year curriculum: 89.4% [95% CI 88.1–90.7] vs. 90.2% [95% CI 88.6–91.8] , p  = 0.492). Conclusions At the beginning of the sub-internship, medical students under the 7-year curriculum had better OSCE performance than those under the 6-year curriculum. After the clinical sub-internship training in Taipei VGH, there was no difference in the national OSCE score between the 6- and 7-year curricula. Our study suggests that clinical sub-internship is crucial for the development of clinical skills and performance in the national OSCE.
    Type of Medium: Online Resource
    ISSN: 1472-6920
    URL: Article
    DOI: 10.1186/s12909-021-03088-7
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
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  • 7
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    Equal Z standard-setting method to estimate the minimum number of panelists for a medical school’s objective structured clinical examination in Taiwan: a simulation study
    Korea Health Personnel Licensing Examination Institute ; 2022
    In:  Journal of Educational Evaluation for Health Professions Vol. 19 ( 2022-10-17), p. 27-
    Details
    In: Journal of Educational Evaluation for Health Professions, Korea Health Personnel Licensing Examination Institute, Vol. 19 ( 2022-10-17), p. 27-
    Abstract: Purpose: Undertaking a standard-setting exercise is a common method for setting pass/fail cut scores for high-stakes examinations. The recently introduced equal Z standard-setting method (EZ method) has been found to be a valid and effective alternative for the commonly used Angoff and Hofstee methods and their variants. The current study aims to estimate the minimum number of panelists required for obtaining acceptable and reliable cut scores using the EZ method.Methods: The primary data were extracted from 31 panelists who used the EZ method for setting cut scores for a 12-station of medical school’s final objective structured clinical examination (OSCE) in Taiwan. For this study, a new data set composed of 1,000 random samples of different panel sizes, ranging from 5 to 25 panelists, was established and analyzed. Analysis of variance was performed to measure the differences in the cut scores set by the sampled groups, across all sizes within each station.Results: On average, a panel of 10 experts or more yielded cut scores with confidence more than or equal to 90% and 15 experts yielded cut scores with confidence more than or equal to 95%. No significant differences in cut scores associated with panel size were identified for panels of 5 or more experts.Conclusion: The EZ method was found to be valid and feasible. Less than an hour was required for 12 panelists to assess 12 OSCE stations. Calculating the cut scores required only basic statistical skills.
    Type of Medium: Online Resource
    ISSN: 1975-5937
    URL: Article
    DOI: 10.3352/jeehp.2022.19.27
    Language: English
    Publisher: Korea Health Personnel Licensing Examination Institute
    Publication Date: 2022
    detail.hit.zdb_id: 2586380-0
    SSG: 5,3
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  • 8
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    Dreyfus scale-based feedback increased medical students’ satisfaction with the complex cluster part of a interviewing and physical examination course and improved skills readiness in Taiwan
    Korea Health Personnel Licensing Examination Institute ; 2019
    In:  Journal of Educational Evaluation for Health Professions Vol. 16 ( 2019-10-11), p. 30-
    Details
    In: Journal of Educational Evaluation for Health Professions, Korea Health Personnel Licensing Examination Institute, Vol. 16 ( 2019-10-11), p. 30-
    Abstract: Purpose: In contrast to the core part of the clinical interviewing and physical examination (PE) skills course, corresponding to the basic, head-to-toe, and thoracic systems, learners need structured feedback in the cluster part of the course, which includes the abdominal, neuromuscular, and musculoskeletal systems. This study evaluated the effects of using Dreyfus scale-based feedback, which has elements of continuous professional development, instead of Likert scale-based feedback in the cluster part of training in Taiwan.Methods: Instructors and final-year medical students in the 2015–2016 classes of National Yang-Ming University, Taiwan comprised the regular cohort, whereas those in the 2017–2018 classes formed the intervention cohort. In the intervention cohort, Dreyfus scale-based feedback, rather than Likert scale-based feedback, was used in the cluster part of the course.Results: In the cluster part of the course in the regular cohort, pre-trained standardized patients rated the class climate as poor, and students expressed low satisfaction with the instructors and course and low self-assessed readiness. In comparison with the regular cohort, improved end-of-course group objective structured clinical examination scores after the cluster part were noted in the intervention cohort. In other words, the implementation of Dreyfus scale-based feedback in the intervention cohort for the cluster part improved the deficit in this section of the course.Conclusion: The implementation of Dreyfus scale-based feedback helped instructors to create a good class climate in the cluster part of the clinical interviewing and PE skills course. Simultaneously, this new intervention achieved the goal of promoting medical students’ readiness for interviewing, PE, and self-directed learning.
    Type of Medium: Online Resource
    ISSN: 1975-5937
    URL: Article
    DOI: 10.3352/jeehp.2019.16.30
    Language: English
    Publisher: Korea Health Personnel Licensing Examination Institute
    Publication Date: 2019
    detail.hit.zdb_id: 2586380-0
    SSG: 5,3
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  • 9
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    Effects of virtual reality training on decreasing the rates of needlestick or sharp injury in new-coming medical and nursing interns in Taiwan
    Korea Health Personnel Licensing Examination Institute ; 2020
    In:  Journal of Educational Evaluation for Health Professions Vol. 17 ( 2020-01-20), p. 1-
    Details
    In: Journal of Educational Evaluation for Health Professions, Korea Health Personnel Licensing Examination Institute, Vol. 17 ( 2020-01-20), p. 1-
    Abstract: Purpose: Senior nursing and medical interns’ lack of familiarity and confidence with respect to practicing universal precaution for the prevention of occupational needlestick or sharp injuries may harm themselves. Trainees’ self-reported needlestick or sharp injury rate was known to be especially high during the first 2 months of internship in Taiwan. This prospective cohort study aimed to assess the effect of newly developed virtual reality (VR) game, which uses Gagne’s learning model to improve universal precaution for needlestick or sharp injury prevention and decrease the rates of needle stick or sharp injuries in new-coming medical and nursing interns in Taiwan.Methods: From 2017 to 2019, the VR system was developed and applied in training of 59 new-coming nursing and 50 medical interns. Occupational needlestick or sharp injury prevention was sought to be achieved through a game of right and wrong choices for safe or unsafe universal precaution behaviors.Results: In comparison with medical interns, a higher proportion of nursing interns had past experiences of deep occupational needlestick or sharp injury. Before VR training, the familiarity and confidence for needlestick or sharp injury prevention were higher among nursing interns than medical interns. Trainees with past experiences of deep needlestick or sharp injury exhibited better performance on the accuracy rate and time needed to complete 20 decisions than those without past experiences in VR practice. All trainees showed an improved performance after VR training. A high proportion of trainees reported that the VR-based training significantly decreased their anxiety about needlestick or sharp injury prevention.Conclusion: This self-developed VR game system using Gagne’s flow improved universal precaution for needlestick or sharp injury prevention and reduced the needlestick or sharp injury rates in the first 2 months of nursing and medical internship.
    Type of Medium: Online Resource
    ISSN: 1975-5937
    URL: Article
    DOI: 10.3352/jeehp.2020.17.1
    Language: English
    Publisher: Korea Health Personnel Licensing Examination Institute
    Publication Date: 2020
    detail.hit.zdb_id: 2586380-0
    SSG: 5,3
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