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This study aimed to conduct a personality-oriented job analysis to identify non-cognitive factors that may predict successful performance or performance difficulties in doctor of physical therapy (DPT) students. The study employed focus groups and a survey with 9 DPT subject matter experts. The focus group participants, who included 3 DPT faculty members and 4 recent graduates of the DPT program, identified 22 non-cognitive factors. Fifteen of these factors were thought to be possibly associated with successful performance and 7 factors were thought to be possibly associated with performance difficulties. Administration of a questionnaire employing the combination job analysis method resulted in 12 factors that could be used in selection, and 10 that could be incorporated into training. The present study employed an established job analysis method using subject matter experts to identify a broad array of factors that go beyond what previous studies have examined, and which may predict success or difficulties in a DPT program.
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Purpose Smart device-based testing (SBT) is being introduced into the Republic of Korea’s high-stakes examination system, starting with the Korean Emergency Medicine Technician Licensing Examination (KEMTLE) in December 2017. In order to minimize the effects of variation in examinees’ environment on test scores, this study aimed to identify any associations of variables related to examinees’ individual characteristics and their perceived acceptability of SBT with their SBT practice test scores.
Methods Of the 569 candidate students who took the KEMTLE on September 12, 2015, 560 responded to a survey questionnaire on the acceptability of SBT after the examination. The questionnaire addressed 8 individual characteristics and contained 2 satisfaction, 9 convenience, and 9 preference items. A comparative analysis according to individual variables was performed. Furthermore, a generalized linear model (GLM) analysis was conducted to identify the effects of individual characteristics and perceived acceptability of SBT on test scores.
Results Among those who preferred SBT over paper-and-pencil testing, test scores were higher for male participants (mean± standard deviation [SD], 4.36± 0.72) than for female participants (mean± SD, 4.21± 0.73). According to the GLM, no variables evaluated— including gender and experience with computer-based testing, SBT, or using a tablet PC—showed a statistically significant relationship with the total score, scores on multimedia items, or scores on text items.
Conclusion Individual characteristics and perceived acceptability of SBT did not affect the SBT practice test scores of emergency medicine technician students in Korea. It should be possible to adopt SBT for the KEMTLE without interference from the variables examined in this study.
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Purpose This study aimed to compare the possible standard-setting methods for the Korean Radiological Technologist Licensing Examination, which has a fixed cut score, and to suggest the most appropriate method.
Methods Six radiological technology professors set standards for 250 items on the Korean Radiological Technologist Licensing Examination administered in December 2016 using the Angoff, Ebel, bookmark, and Hofstee methods.
Results With a maximum percentile score of 100, the cut score for the examination was 71.27 using the Angoff method, 62.2 using the Ebel method, 64.49 using the bookmark method, and 62 using the Hofstee method. Based on the Hofstee method, an acceptable cut score for the examination would be between 52.83 and 70, but the cut score was 71.27 using the Angoff method.
Conclusion The above results suggest that the best standard-setting method to determine the cut score would be a panel discussion with the modified Angoff or Ebel method, with verification of the rated results by the Hofstee method. Since no standard-setting method has yet been adopted for the Korean Radiological Technologist Licensing Examination, this study will be able to provide practical guidance for introducing a standard-setting process.
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Purpose Traditionally, the morbidity and mortality conference (M&MC) is a forum where possible medical errors are discussed. Although M&MCs can facilitate identification of opportunities for systemwide improvements, few studies have described their use for this purpose, particularly in residency training programs. This paper describes the use of M&MC case review as a quality improvement activity that teaches system-based practice and can engage residents in improving systems of care.
Methods Internal medicine residents at a tertiary care academic medical center reviewed 347 consecutive mortalities from March 2014 to September 2017. The residents used case review worksheets to categorize and track causes of mortality, and then debriefed with a faculty member. Selected cases were then presented at a larger interdepartmental meeting and action items were implemented. Descriptive statistics and thematic analysis were used to analyze the results.
Results The residents identified a possible diagnostic mismatch at some point from admission to death in 54.5% of cases (n= 189) and a possible need for improved management in 48.0% of cases. Three possible management failure themes were identified, including failure to plan, failure to communicate, and failure to rescue, which accounted for 21.9%, 10.7 %, and 10.1% of cases, respectively. Following these reviews, quality improvement initiatives proposed by residents led to system-based changes.
Conclusion A resident-driven mortality review curriculum can lead to improvements in systems of care. This novel type of curriculum can be used to teach system-based practice. The recruitment of teaching faculty with expertise in quality improvement and mortality case analyses is essential for such a project.
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Clinical reasoning (CR) is a key learning domain for physical therapy educators and a core skill for entry-level practitioners. Integrated clinical experience (ICE) and problem-based learning (PBL) have each been reported to improve interpersonal and social domains, while promoting knowledge acquisition and CR. Unfortunately, studies monitoring CR during ICE with concurrent PBL in physical therapy education are sparse. We hypothesized that ICE with concurrent PBL would be associated with improved self-reported CR in third-year student physical therapists (PTs) in the United States. The Self-Assessment of Clinical Reflection and Reasoning (SACRR) survey was administered to 42 student PTs at the beginning and end of their third and final year of didactic training. Between the pretest and posttest analyses, the participants completed faculty-led ICE and PBL coursework for 16 weeks. The overall SACRR score and 26 individual item scores were examined. The Wilcoxon rank-sum test and paired t-test were used, with statistical significance accepted at P< 0.05. Significant improvements were observed in the overall SACRR score (P< 0.001), including 6 of the 26 survey items centered around decision-making based on experience and evidence, as well as self-reflection and reasoning. ICE with PBL was associated with improved self-assessed CR and reflection in third-year student PTs in the United States. Monitoring the impact of curricular design on CR may improve educators’ ability to enhance cognitive and psychomotor skills, which underscores the importance of increasing the explicit use of theoretical frameworks and teaching techniques for coping with uncertainty as a way of enhancing entry-level training.
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Methods This study was carried out among 77 operating room nursing students from the first to the fourth years studying at the School of Nursing and Midwifery of Isfahan University of Medical Sciences in the academic year 2017–2018. The intervention administered to the experimental group included a 12-hour training program on expressing empathy to patients that incorporated roleplaying. The Jefferson Scale of Empathy-Health Profession Student version was completed by the participants before, immediately after, and 1 month after the intervention. A comparative analysis of these 3 time points was conducted.
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Purpose It is assumed that case-based questions require higher-order cognitive processing, whereas questions that are not case-based require lower-order cognitive processing. In this study, we investigated to what extent case-based and non-case-based questions followed this assumption based on Bloom’s taxonomy.
Methods In this article, 4,800 questions from the Interuniversity Progress Test of Medicine were classified based on whether they were case-based and on the level of Bloom’s taxonomy that they involved. Lower-order questions require students to remember or/and have a basic understanding of knowledge. Higher-order questions require students to apply, analyze, or/and evaluate. The phi coefficient was calculated to investigate the relationship between whether questions were case-based and the required level of cognitive processing.
Results Our results demonstrated that 98.1% of case-based questions required higher-level cognitive processing. Of the non-case-based questions, 33.7% required higher-level cognitive processing. The phi coefficient demonstrated a significant, but moderate correlation between the presence of a patient case in a question and its required level of cognitive processing (phi coefficient= 0.55, P< 0.001).
Conclusion Medical instructors should be aware of the association between item format (case-based versus non-case-based) and the cognitive processes they elicit in order to meet the desired balance in a test, taking the learning objectives and the test difficulty into account.
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Purpose This study aimed to identify the best way of developing equivalent item sets and to propose a stable and effective management plan for periodical licensing examinations.
Methods Five pre-equated item sets were developed based on the predicted correct answer rate of each item using linear programming. These pre-equated item sets were compared to the ones that were developed with a random item selection method based on the actual correct answer rate (ACAR) and difficulty from item response theory (IRT). The results with and without common items were also compared in the same way. ACAR and the IRT difficulty were used to determine whether there was a significant difference between the pre-equating conditions.
Results There was a statistically significant difference in IRT difficulty among the results from different pre-equated conditions. The predicted correct answer rate was divided using 2 or 3 difficulty categories, and the ACAR and IRT difficulty parameters of the 5 item sets were equally constructed. Comparing the item set conditions with and without common items, including common items did not make a significant contribution to the equating of the 5 item sets.
Conclusion This study suggested that the linear programming method is applicable to construct equated-item sets that reflect each content area. The suggested best method to construct equated item sets is to divide the predicted correct answer rate using 2 or 3 difficulty categories, regardless of common items. If pre-equated item sets are required to construct a test based on the actual data, several methods should be considered by simulation studies to determine which is optimal before administering a real test.
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In addition to online questionnaires, many medical schools use supplemental evaluation tools such as focus groups to evaluate their courses. Although some benefits of using focus groups in program evaluation have been described, it is unknown whether these inperson data collection methods provide sufficient additional information beyond online evaluations to justify them. In this study, we analyze recommendations gathered from student evaluation team (SET) focus group meetings and analyzed whether these items were captured in open-ended comments within the online evaluations. Our results indicate that online evaluations captured only 49% of the recommendations identified via SETs. Surveys to course directors identified that 74% of the recommendations exclusively identified via the SETs were implemented within their courses. Our results indicate that SET meetings provided information not easily captured in online evaluations and that these recommendations resulted in actual course changes.
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Methods Learning experiences after using the YouTube platform to deliver preliminary video lectures in a flipped classroom were assessed by 69 second-year students (52 males, 17 females) at Dankook University College of Dentistry, Korea, who attended periodontology lectures during 2 consecutive semesters of the 2016 academic year. The instructor uploaded the lecture videos to YouTube before each class. At the end of the second semester, the students were surveyed using a questionnaire devised by the authors.
Results Of the students, 53 (76.8%) always watched the lecture before the class, 48 (69.6%) used their smartphones, and 66 (95.7%) stated that they watched the lectures at home. The majority of the students replied that the video lectures were easier to understand than face to face lectures (82.6%) and that they would like to view the videos again after graduation (73.9%).
Conclusion Our results indicate that YouTube is an applicable platform to deliver video lectures and to expose students to increased learning opportunities.
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Purpose This study aimed to assess the agreement between 2 raters in evaluations of students on a prosthodontic clinical practical exam integrated with directly observed procedural skills (DOPS).
Methods A sample of 76 students was monitored by 2 raters to evaluate the process and the final registered maxillomandibular relation for a completely edentulous patient at Mansoura Dental School, Egypt on a practical exam of bachelor’s students from May 15 to June 28, 2017. Each registered relation was evaluated from a total of 60 marks subdivided into 3 score categories: occlusal plane orientation (OPO), vertical dimension registration (VDR), and centric relation registration (CRR). The marks for each category included an assessment of DOPS. The marks of OPO and VDR for both raters were compared using the graph method to measure reliability through Bland and Altman analysis. The reliability of the CRR marks was evaluated by the Krippendorff alpha ratio.
Results The results revealed highly similar marks between raters for OPO (mean= 18.1 for both raters), with close limits of agreement (0.73 and −0.78). For VDR, the mean marks were close (mean= 17.4 and 17.1 for examiners 1 and 2, respectively), with close limits of agreement (2.7 and −2.2). There was a strong correlation (Krippendorff alpha ratio, 0.92; 95% confidence interval, 0.79– 0.99) between the raters in the evaluation of CRR.
Conclusion The 2 raters’ evaluation of a clinical traditional practical exam integrated with DOPS showed no significant differences in the evaluations of candidates at the end of a clinical prosthodontic course. The limits of agreement between raters could be optimized by excluding subjective evaluation parameters and complicated cases from the examination procedure.
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Purpose Peer assessment provides a framework for developing expected skills and receiving feedback appropriate to the learner’s level. Near-peer (NP) assessment may elevate expectations and motivate learning. Feedback from peers and NPs may be a sustainable way to enhance student assessment feedback. This study analysed relationships among self, peer, NP, and faculty marking of an assessment and students’ attitudes towards marking by those various groups.
Methods A cross-sectional study design was used. Year 2 osteopathy students (n= 86) were invited to perform self and peer assessments of a clinical history-taking and communication skills assessment. NPs and faculty also marked the assessment. Year 2 students also completed a questionnaire on their attitudes to peer/NP marking. Descriptive statistics and the Spearman rho coefficient were used to evaluate relationships across marker groups.
Results Year 2 students (n= 9), NPs (n= 3), and faculty (n= 5) were recruited. Correlations between self and peer (r= 0.38) and self and faculty (r= 0.43) marks were moderate. A weak correlation was observed between self and NP marks (r= 0.25). Perceptions of peer and NP marking varied, with over half of the cohort suggesting that peer or NP assessments should not contribute to their grade.
Conclusion Framing peer and NP assessment as another feedback source may offer a sustainable method for enhancing feedback without overloading faculty resources. Multiple sources of feedback may assist in developing assessment literacy and calibrating students’ self-assessment capability. The small number of students recruited suggests some acceptability of peer and NP assessment; however, further work is required to increase its acceptability.
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