Journal of Educational Evaluation for Health Professions

Volume 20; 2023

Research articles

Effect of a transcultural nursing course on improving the cultural competency of nursing graduate students in Korea: a before-and-after study: Kyung Eui Bae, Geum Hee Jeong; J Educ Eval Health Prof. 2023;20:35. Published online December 4, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.35 [Epub ahead of print]

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Abstract PDF: Purpose
This study aimed to evaluate the impact of a transcultural nursing course on enhancing the cultural competency of graduate nursing students in Korea. We hypothesized that participants’ cultural competency would significantly improve in areas such as communication, biocultural ecology and family, dietary habits, death rituals, spirituality, equity, and empowerment and intermediation after completing the course. Furthermore, we assessed the participants’ overall satisfaction with the course.
Methods
A before-and-after study was conducted with graduate nursing students at Hallym University, Chuncheon, Korea, from March to June 2023. A transcultural nursing course was developed based on Giger & Haddad’s transcultural nursing model and Purnell’s theoretical model of cultural competence. Data was collected using a cultural competence scale for registered nurses developed by Kim et al. A total of 18 students participated, and the paired t-test was employed to compare pre-and post-intervention scores.
Results
The study revealed significant improvements in all 7 categories of cultural nursing competence (P<0.01). Specifically, the mean differences in scores (pre–post) ranged from 0.74 to 1.09 across the categories. Additionally, participants expressed high satisfaction with the course, with an average score of 4.72 out of a maximum of 5.0.
Conclusion
The transcultural nursing course effectively enhanced the cultural competency of graduate nursing students. Such courses are imperative to ensure quality care for the increasing multicultural population in Korea.

Effect of motion-graphic video-based training on the performance of operating room nurse students in cataract surgery in Iran: a randomized controlled study: Behnaz Fatahi, Samira Fatahi, Sohrab Nosrati, Masood Bagheri; J Educ Eval Health Prof. 2023;20:34. Published online November 28, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.34 [Epub ahead of print]

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Abstract PDF: Purpose
The present study was conducted to determine the effect of motion-graphic video-based training on the performance of operating room nurse students in cataract surgery using phacoemulsification at Kermanshah University of Medical Sciences in Iran.
Methods
This was a randomized controlled study conducted among 36 students training to become operating room nurses. The control group only received routine training, and the intervention group received motion-graphic video-based training on the scrub nurse’s performance in cataract surgery in addition to the educator’s training. The performance of the students in both groups as scrub nurses was measured through a researcher-made checklist in a pre-test and a post-test.
Results
The mean scores for performance in the pre-test and post-test were 17.83 and 26.44 in the control group and 18.33 and 50.94 in the intervention group, respectively, and a significant difference was identified between the mean scores of the pre- and post-test in both groups (P=0.001). The intervention also led to a significant increase in the mean performance score in the intervention group compared to the control group (P=0.001).
Conclusion
Considering the significant difference in the performance score of the intervention group compared to the control group, motion-graphic video-based training had a positive effect on the performance of operating room nurse students, and such training can be used to improve clinical training.

Assessment of the viability of integrating virtual reality programs in practical tests for the Korean Radiological Technologists Licensing Examination: a survey study: Hye Min Park, Eun Seong Kim, Deok Mun Kwon, Pyong Kon Cho, Seoung Hwan Kim, Ki Beak Lee, Seong Hu Kim, Moon Il Bong, Won Seok Yang, Jin Eui Kim, Gi Bong Kang, Yong Su Yoon, Jung Su Kim; J Educ Eval Health Prof. 2023;20:33. Published online November 28, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.33 [Epub ahead of print]

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Abstract PDF: Purpose
The objective of this study was to assess the feasibility of incorporating virtual reality/augmented reality (VR/AR) programs into practical tests administered as part of the Korean Radiological Technologists Licensing Examination (KRTLE). This evaluation is grounded in a comprehensive survey that targeted enrolled students in departments of radiology across the nation.
Methods
In total, 682 students from radiology departments across the nation were participants in the survey. An online survey platform was used, and the questionnaire was structured into 5 distinct sections and 27 questions. A frequency analysis for each section of the survey was conducted using IBM SPSS ver. 27.0.
Results
Direct or indirect exposure to VR/AR content was reported by 67.7% of all respondents. Furthermore, 55.4% of the respondents expressed that VR/AR could be integrated into their classes, which signified a widespread acknowledgment of VR among the students. With regards to the integration of a VR/AR or mixed reality program into the practical tests for purposes of the KRTLE, a substantial amount of the respondents (57.3%) exhibited a positive inclination and recommended its introduction.
Conclusion
The application of VR/AR programs within practical tests of the KRTLE will be used as an alternative for evaluating clinical examination procedures and validating job skills.

Brief report

ChatGPT (GPT-3.5) as an assistant tool in microbial pathogenesis studies in Sweden: a cross-sectional comparative study: Catharina Hultgren, Annica Lindkvist, Volkan Özenci, Sophie Curbo; J Educ Eval Health Prof. 2023;20:32. Published online November 22, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.32

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Abstract PDF: ChatGPT (GPT-3.5) has entered higher education and there is a need to determine how to use it effectively. This descriptive study compared the ability of GPT-3.5 and teachers to answer questions from dental students and construct detailed intended learning outcomes. When analyzed according to a Likert scale, we found that GPT-3.5 answered the questions from dental students in a similar or even more elaborate way compared to the answers that had previously been provided by a teacher. GPT-3.5 was also asked to construct detailed intended learning outcomes for a course in microbial pathogenesis, and when these were analyzed according to a Likert scale they were, to a large degree, found irrelevant. Since students are using GPT-3.5, it is important that instructors learn how to make the best use of it both to be able to advise students and to benefit from its potential.

Technical report

Item difficulty index, discrimination index, and reliability of the 26 health professions licensing examinations in 2022, Korea: a psychometric study: Yoon Hee Kim, Bo Hyun Kim, Joonki Kim, Bokyoung Jung, Sangyoung Bae; J Educ Eval Health Prof. 2023;20:31. Published online November 22, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.31

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Abstract PDF: Purpose
This study presents item analysis results of the 26 health personnel licensing examinations managed by the Korea Health Personnel Licensing Examination Institute (KHPLEI) in 2022.
Methods
The item difficulty index, item discrimination index, and reliability were calculated. The item discrimination index was calculated using a discrimination index based on the upper and lower 27% rule and the item-total correlation.
Results
Out of 468,352 total examinees, 418,887 (89.4%) passed. The pass rates ranged from 27.3% for health educators level 1 to 97.1% for oriental medical doctors. Most examinations had a high average difficulty index, albeit to varying degrees, ranging from 61.3% for prosthetists and orthotists to 83.9% for care workers. The average discrimination index based on the upper and lower 27% rule ranged from 0.17 for oriental medical doctors to 0.38 for radiological technologists. The average item-total correlation ranged from 0.20 for oriental medical doctors to 0.38 for radiological technologists. The Cronbach α, as a measure of reliability, ranged from 0.872 for health educators-level 3 to 0.978 for medical technologists. The correlation coefficient between the average difficulty index and average discrimination index was -0.2452 (P=0.1557), that between the average difficulty index and the average item-total correlation was 0.3502 (P=0.0392), and that between the average discrimination index and the average item-total correlation was 0.7944 (P<0.0001).
Conclusion
This technical report presents the item analysis results and reliability of the recent examinations by the KHPLEI, demonstrating an acceptable range of difficulty index and discrimination index values, as well as good reliability.

Research articles

Performance of ChatGPT, Bard, Claude, and Bing on the Peruvian National Licensing Medical Examination: a cross-sectional study: Betzy Clariza Torres-Zegarra, Wagner Rios-Garcia, Alvaro Micael Ñaña-Cordova, Karen Fatima Arteaga-Cisneros, Xiomara Cristina Benavente Chalco, Marina Atena Bustamante Ordoñez, Carlos Jesus Gutierrez Rios, Carlos Alberto Ramos Godoy, Kristell Luisa Teresa Panta Quezada, Jesus Daniel Gutierrez-Arratia, Javier Alejandro Flores-Cohaila; J Educ Eval Health Prof. 2023;20:30. Published online November 20, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.30

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Abstract PDF: Purpose
We aimed to describe the performance and evaluate the educational value of justifications provided by artificial intelligence chatbots, including GPT-3.5, GPT-4, Bard, Claude, and Bing, on the Peruvian National Medical Licensing Examination (P-NLME).
Methods
This was a cross-sectional analytical study. On July 25, 2023, each multiple-choice question (MCQ) from the P-NLME was entered into each chatbot (GPT-3, GPT-4, Bing, Bard, and Claude) 3 times. Then, 4 medical educators categorized the MCQs in terms of medical area, item type, and whether the MCQ required Peru-specific knowledge. They assessed the educational value of the justifications from the 2 top performers (GPT-4 and Bing).
Results
GPT-4 scored 86.7% and Bing scored 82.2%, followed by Bard and Claude, and the historical performance of Peruvian examinees was 55%. Among the factors associated with correct answers, only MCQs that required Peru-specific knowledge had lower odds (odds ratio, 0.23; 95% confidence interval, 0.09–0.61), whereas the remaining factors showed no associations. In assessing the educational value of justifications provided by GPT-4 and Bing, neither showed any significant differences in certainty, usefulness, or potential use in the classroom.
Conclusion
Among chatbots, GPT-4 and Bing were the top performers, with Bing performing better at Peru-specific MCQs. Moreover, the educational value of justifications provided by the GPT-4 and Bing could be deemed appropriate. However, it is essential to start addressing the educational value of these chatbots, rather than merely their performance on examinations.

Medical students’ patterns of using ChatGPT as a feedback tool and perceptions of ChatGPT in a Leadership and Communication course in Korea: a cross-sectional study: Janghee Park; J Educ Eval Health Prof. 2023;20:29. Published online November 10, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.29

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Abstract PDF: Purpose
This study aimed to analyze patterns of using ChatGPT before and after group activities and to explore medical students’ perceptions of ChatGPT as a feedback tool in the classroom.
Methods
The study included 99 2nd-year pre-medical students who participated in a “Leadership and Communication” course from March to June 2023. Students engaged in both individual and group activities related to negotiation strategies. ChatGPT was used to provide feedback on their solutions. A survey was administered to assess students’ perceptions of ChatGPT’s feedback, its use in the classroom, and the strengths and challenges of ChatGPT from May 17 to 19, 2023.
Results
The students responded by indicating that ChatGPT’s feedback was helpful, and revised and resubmitted their group answers in various ways after receiving feedback. The majority of respondents expressed agreement with the use of ChatGPT during class. The most common response concerning the appropriate context of using ChatGPT’s feedback was “after the first round of discussion, for revisions.” There was a significant difference in satisfaction with ChatGPT’s feedback, including correctness, usefulness, and ethics, depending on whether or not ChatGPT was used during class, but there was no significant difference according to gender or whether students had previous experience with ChatGPT. The strongest advantages were “providing answers to questions” and “summarizing information,” and the worst disadvantage was “producing information without supporting evidence.”
Conclusion
The students were aware of the advantages and disadvantages of ChatGPT, and they had a positive attitude toward using ChatGPT in the classroom.

Efficacy and limitations of ChatGPT as a biostatistical problem-solving tool in medical education in Serbia: a descriptive study: Aleksandra Ignjatović, Lazar Stevanović; J Educ Eval Health Prof. 2023;20:28. Published online October 16, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.28

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Abstract PDF Supplementary Material: Purpose
This study aimed to assess the performance of ChatGPT (GPT-3.5 and GPT-4) as a study tool in solving biostatistical problems and to identify any potential drawbacks that might arise from using ChatGPT in medical education, particularly in solving practical biostatistical problems.
Methods
ChatGPT was tested to evaluate its ability to solve biostatistical problems from the Handbook of Medical Statistics by Peacock and Peacock in this descriptive study. Tables from the problems were transformed into textual questions. Ten biostatistical problems were randomly chosen and used as text-based input for conversation with ChatGPT (versions 3.5 and 4).
Results
GPT-3.5 solved 5 practical problems in the first attempt, related to categorical data, cross-sectional study, measuring reliability, probability properties, and the t-test. GPT-3.5 failed to provide correct answers regarding analysis of variance, the chi-square test, and sample size within 3 attempts. GPT-4 also solved a task related to the confidence interval in the first attempt and solved all questions within 3 attempts, with precise guidance and monitoring.
Conclusion
The assessment of both versions of ChatGPT performance in 10 biostatistical problems revealed that GPT-3.5 and 4’s performance was below average, with correct response rates of 5 and 6 out of 10 on the first attempt. GPT-4 succeeded in providing all correct answers within 3 attempts. These findings indicate that students must be aware that this tool, even when providing and calculating different statistical analyses, can be wrong, and they should be aware of ChatGPT’s limitations and be careful when incorporating this model into medical education.

Mentorship and self-efficacy are associated with lower burnout in physical therapists in the United States: a cross-sectional survey study: Matthew S. Pugliese, Jean-Michel Brismée, Brad Allen, Sean P. Riley, Justin Tammany, Paul Mintken; J Educ Eval Health Prof. 2023;20:27. Published online September 27, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.27

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Abstract PDF Supplementary Material: Purpose
This study investigated the prevalence of burnout in physical therapists in the United States and the relationships between burnout and education, mentorship, and self-efficacy.
Methods
This was a cross-sectional survey study. An electronic survey was distributed to practicing physical therapists across the United States over a 6-week period from December 2020 to January 2021. The survey was completed by 2,813 physical therapists from all states. The majority were female (68.72%), White or Caucasian (80.13%), and employed full-time (77.14%). Respondents completed questions on demographics, education, mentorship, self-efficacy, and burnout. The Burnout Clinical Subtypes Questionnaire 12 (BCSQ-12) and self-reports were used to quantify burnout, and the General Self-Efficacy Scale (GSES) was used to measure self-efficacy. Descriptive and inferential analyses were performed.
Results
Respondents from home health (median BCSQ-12=42.00) and skilled nursing facility settings (median BCSQ-12=42.00) displayed the highest burnout scores. Burnout was significantly lower among those who provided formal mentorship (median BCSQ-12=39.00, P=0.0001) compared to no mentorship (median BCSQ-12=41.00). Respondents who received formal mentorship (median BCSQ-12=38.00, P=0.0028) displayed significantly lower burnout than those who received no mentorship (median BCSQ-12=41.00). A moderate negative correlation (rho=-0.49) was observed between the GSES and burnout scores. A strong positive correlation was found between self-reported burnout status and burnout scores (rrb=0.61).
Conclusion
Burnout is prevalent in the physical therapy profession, as almost half of respondents (49.34%) reported burnout. Providing or receiving mentorship and higher self-efficacy were associated with lower burnout. Organizations should consider measuring burnout levels, investing in mentorship programs, and implementing strategies to improve self-efficacy.

Development and validation of the student ratings in clinical teaching scale in Australia: a methodological study: Pin-Hsiang Huang, Anthony John O’Sullivan, Boaz Shulruf; J Educ Eval Health Prof. 2023;20:26. Published online September 5, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.26

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Abstract PDF Supplementary Material: Purpose
This study aimed to devise a valid measurement for assessing clinical students’ perceptions of teaching practices.
Methods
A new tool was developed based on a meta-analysis encompassing effective clinical teaching-learning factors. Seventy-nine items were generated using a frequency (never to always) scale. The tool was applied to the University of New South Wales year 2, 3, and 6 medical students. Exploratory and confirmatory factor analysis (exploratory factor analysis [EFA] and confirmatory factor analysis [CFA], respectively) were conducted to establish the tool’s construct validity and goodness of fit, and Cronbach’s α was used for reliability.
Results
In total, 352 students (44.2%) completed the questionnaire. The EFA identified student-centered learning, problem-solving learning, self-directed learning, and visual technology (reliability, 0.77 to 0.89). CFA showed acceptable goodness of fit (chi-square P<0.01, comparative fit index=0.930 and Tucker-Lewis index=0.917, root mean square error of approximation=0.069, standardized root mean square residual=0.06).
Conclusion
The established tool—Student Ratings in Clinical Teaching (STRICT)—is a valid and reliable tool that demonstrates how students perceive clinical teaching efficacy. STRICT measures the frequency of teaching practices to mitigate the biases of acquiescence and social desirability. Clinical teachers may use the tool to adapt their teaching practices with more active learning activities and to utilize visual technology to facilitate clinical learning efficacy. Clinical educators may apply STRICT to assess how these teaching practices are implemented in current clinical settings.

Effect of an interprofessional simulation program on patient safety competencies of healthcare professionals in Switzerland: a before and after study: Sylvain Boloré, Thomas Fassier, Nicolas Guirimand; J Educ Eval Health Prof. 2023;20:25. Published online August 28, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.25

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Abstract PDF Supplementary Material: Purpose
This study aimed to identify the effects of a 12-week interprofessional simulation program, operated between February 2020 and January 2021, on the patient safety competencies of healthcare professionals in Switzerland.
Methods
The simulation training was based on 2 scenarios of hospitalized patients with septic shock and respiratory failure, and trainees were expected to demonstrate patient safety competencies. A single-group before and after study was conducted after the intervention—simulation program, using a measurement tool (the Health Professional Education in Patient Safety Survey) to measure the perceived competencies of physicians, nurses, and nursing assistants. Out of 57 participants, 37 answered the questionnaire surveys 4 times: 48 hours before the training, followed by post-surveys at 24 hours, 6 weeks, and 12 weeks after the training. The linear mixed effect model was applied for the analysis.
Results
Four components out of 6 perceived patient safety competencies improved at 6 weeks but returned to a similar level before training at 12 weeks. Competencies of “communicating effectively,” “managing safety risks,” “understanding human and environmental factors that influence patient safety,” and “recognize and respond to remove immediate risks of harm” are statistically significant both overall and in the comparison between before the training and 6 weeks after the training.
Conclusion
Interprofessional simulation programs contributed to developing some areas of patient safety competencies of healthcare professionals, but only for a limited time. Interprofessional simulation programs should be repeated and combined with other forms of support, including case discussions and debriefings, to ensure lasting effects.

Review

How to review and assess a systematic review and meta-analysis article: a methodological study (secondary publication): Seung-Kwon Myung; J Educ Eval Health Prof. 2023;20:24. Published online August 27, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.24

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Abstract PDF Supplementary Material: Systematic reviews and meta-analyses have become central in many research fields, particularly medicine. They offer the highest level of evidence in evidence-based medicine and support the development and revision of clinical practice guidelines, which offer recommendations for clinicians caring for patients with specific diseases and conditions. This review summarizes the concepts of systematic reviews and meta-analyses and provides guidance on reviewing and assessing such papers. A systematic review refers to a review of a research question that uses explicit and systematic methods to identify, select, and critically appraise relevant research. In contrast, a meta-analysis is a quantitative statistical analysis that combines individual results on the same research question to estimate the common or mean effect. Conducting a meta-analysis involves defining a research topic, selecting a study design, searching literature in electronic databases, selecting relevant studies, and conducting the analysis. One can assess the findings of a meta-analysis by interpreting a forest plot and a funnel plot and by examining heterogeneity. When reviewing systematic reviews and meta-analyses, several essential points must be considered, including the originality and significance of the work, the comprehensiveness of the database search, the selection of studies based on inclusion and exclusion criteria, subgroup analyses by various factors, and the interpretation of the results based on the levels of evidence. This review will provide readers with helpful guidance to help them read, understand, and evaluate these articles.

Research articles

Implementation strategy for introducing a clinical skills examination to the Korean Oriental Medicine Licensing Examination: a mixed-method modified Delphi study: Chan-Young Kwon, Sanghoon Lee, Min Hwangbo, Chungsik Cho, Sangwoo Shin, Dong-Hyeon Kim, Aram Jeong, Hye-Yoon Lee; J Educ Eval Health Prof. 2023;20:23. Published online July 17, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.23

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Abstract PDF Supplementary Material: Purpose
This study investigated the validity of introducing a clinical skills examination (CSE) to the Korean Oriental Medicine Licensing Examination through a mixed-method modified Delphi study.
Methods
A 3-round Delphi study was conducted between September and November 2022. The expert panel comprised 21 oriental medicine education experts who were officially recommended by relevant institutions and organizations. The questionnaires included potential content for the CSE and a detailed implementation strategy. Subcommittees were formed to discuss concerns around the introduction of the CSE, which were collected as open-ended questions. In this study, a 66.7% or greater agreement rate was defined as achieving a consensus.
Results
The expert panel’s evaluation of the proposed clinical presentations and basic clinical skills suggested their priorities. Of the 10 items investigated for building a detailed implementation strategy for the introduction of the CSE to the Korean Oriental Medicine Licensing Examination, a consensus was achieved on 9. However, the agreement rate on the timing of the introduction of the CSE was low. Concerns around 4 clinical topics were discussed in the subcommittees, and potential solutions were proposed.
Conclusion
This study offers preliminary data and raises some concerns that can be used as a reference while discussing the introduction of the CSE to the Korean Oriental Medicine Licensing Examination.

Experience of introducing an electronic health records station in an objective structured clinical examination to evaluate medical students’ communication skills in Canada: a descriptive study: Kuan-chin Jean Chen, Ilona Bartman, Debra Pugh, David Topps, Isabelle Desjardins, Melissa Forgie, Douglas Archibald; J Educ Eval Health Prof. 2023;20:22. Published online July 4, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.22

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Abstract PDF Supplementary Material: Purpose
There is limited literature related to the assessment of electronic medical record (EMR)-related competencies. To address this gap, this study explored the feasibility of an EMR objective structured clinical examination (OSCE) station to evaluate medical students’ communication skills by psychometric analyses and standardized patients’ (SPs) perspectives on EMR use in an OSCE.
Methods
An OSCE station that incorporated the use of an EMR was developed and pilot-tested in March 2020. Students’ communication skills were assessed by SPs and physician examiners. Students’ scores were compared between the EMR station and 9 other stations. A psychometric analysis, including item total correlation, was done. SPs participated in a post-OSCE focus group to discuss their perception of EMRs’ effect on communication.
Results
Ninety-nine 3rd-year medical students participated in a 10-station OSCE that included the use of the EMR station. The EMR station had an acceptable item total correlation (0.217). Students who leveraged graphical displays in counseling received higher OSCE station scores from the SPs (P=0.041). The thematic analysis of SPs’ perceptions of students’ EMR use from the focus group revealed the following domains of themes: technology, communication, case design, ownership of health information, and timing of EMR usage.
Conclusion
This study demonstrated the feasibility of incorporating EMR in assessing learner communication skills in an OSCE. The EMR station had acceptable psychometric characteristics. Some medical students were able to efficiently use the EMRs as an aid in patient counseling. Teaching students how to be patient-centered even in the presence of technology may promote engagement.

Editorial

Journal of Educational Evaluation for Health Professions received the Journal Impact Factor, 4.4 for the first time on June 28, 2023: Sun Huh; J Educ Eval Health Prof. 2023;20:21. Published online June 29, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.21

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