Journal of Educational Evaluation for Health Professions

Review

Performance of large language models in medical licensing examinations: a systematic review and meta-analysis: Haniyeh Nouri, Abdollah Mahdavi, Ali Abedi, Alireza Mohammadnia, Mahnaz Hamedan, Masoud Amanzadeh; J Educ Eval Health Prof. 2025;22:36. Published online November 18, 2025; DOI: https://doi.org/10.3352/jeehp.2025.22.36 [Epub ahead of print]

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Abstract PDF Supplementary Material: Purpose
This study systematically evaluates and compares the performance of large language models (LLMs) in answering medical licensing examination questions. By conducting subgroup analyses based on language, question format, and model type, this meta-analysis aims to provide a comprehensive overview of LLM capabilities in medical education and clinical decision-making.
Methods
This systematic review, registered in PROSPERO and following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, searched MEDLINE (PubMed), Scopus, and Web of Science for relevant articles published up to February 1, 2025. The search strategy included Medical Subject Headings (MeSH) terms and keywords related to (“ChatGPT” OR “GPT” OR “LLM variants”) AND (“medical licensing exam*” OR “medical exam*” OR “medical education” OR “radiology exam*”). Eligible studies evaluated LLM accuracy on medical licensing examination questions. Pooled accuracy was estimated using a random-effects model, with subgroup analyses by LLM type, language, and question format. Publication bias was assessed using Egger’s regression test.
Results
This systematic review identified 2,404 studies. After removing duplicates and excluding irrelevant articles through title and abstract screening, 36 studies were included after full-text review. The pooled accuracy was 72% (95% confidence interval, 70.0% to 75.0%) with high heterogeneity (I2=99%, P<0.001). Among LLMs, GPT-4 achieved the highest accuracy (81%), followed by Bing (79%), Claude (74%), Gemini/Bard (70%), and GPT-3.5 (60%) (P=0.001). Performance differences across languages (range, 62% in Polish to 77% in German) were not statistically significant (P=0.170).
Conclusion
LLMs, particularly GPT-4, can match or exceed medical students’ examination performance and may serve as supportive educational tools. However, due to variability and the risk of errors, they should be used cautiously as complements rather than replacements for traditional learning methods.

Research articles

Perceptions of faculty and medical students regarding an undergraduate research culture activity in Myanmar: a qualitative study: Htain Lin Aung, Moe Oo Thant, July Maung Maung, Ye Hlaing Oo, Thin Thin Toe, Hla Moe; J Educ Eval Health Prof. 2025;22:33. Published online October 27, 2025; DOI: https://doi.org/10.3352/jeehp.2025.22.33

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Abstract PDF Supplementary Material: Purpose
This study explored the perceptions of faculty members and third-year medical students regarding the research culture activity (RCA), a program designed to engage undergraduates in research at the University of Medicine, Mandalay, Myanmar. It aimed to identify the knowledge, attitudes, and skills (KAS) gained, the challenges encountered, and suggestions for improvement.
Methods
This qualitative study employed 4 semi-structured focus group discussions with 17 third-year medical students and 16 faculty members who participated in the 2020 RCA. Student responses related to KAS were analyzed using a deductive framework approach, while challenges and suggestions were examined through inductive thematic analysis. Discussions were audio-recorded, transcribed verbatim in Burmese, translated into English, and collaboratively coded using Atlas.ti version 9.0.5.
Results
Participants reported improved understanding of scientific literature, greater responsibility, strengthened teamwork, and enhanced practical research skills. Reported challenges included limited research preparedness, scheduling conflicts, inconsistent supervision, financial constraints, and weak coordination with inpatient clinicians. Participants also suggested clearer guidelines, pre-research training, protected time, stronger supervision, and institutional budgetary support.
Conclusion
The RCA provides substantial educational value in developing research competencies and remains a promising, potentially adaptable model for resource-limited settings. Its sustainability will depend on institutional commitment, supervisory capacity, and modest financial investment. Future research should prospectively assess KAS outcomes, compare supervision models and group sizes, evaluate digital workflows for efficiency, and conduct long-term follow-up of graduates’ scholarly activities to build evidence for scalable implementation.

The impact of differential item functioning on ability estimation using the Korean Medical License Examination with computerized adaptive testing: a post-hoc simulation study: Dogyeong Kim, Jeongwook Choi, Dong Gi Seo; J Educ Eval Health Prof. 2025;22:31. Published online October 10, 2025; DOI: https://doi.org/10.3352/jeehp.2025.22.31 [Epub ahead of print]

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Abstract PDF: Purpose
This study examined the impact of differential item functioning (DIF) on ability estimation in a computerized adaptive testing (CAT) environment using real response data from the 2017 Korean Medical Licensing Examination (KMLE). We hypothesized that excluding gender-based DIF items would improve estimation accuracy, particularly for examinees at the extremes of the ability scale.
Methods
The study was conducted in 2 steps: (1) DIF detection and (2) post-hoc simulation. The analysis used data from 3,259 examinees who completed all 360 dichotomous items. Gender-based DIF was detected with the residual-based DIF method (reference group: males; focal group: females). Two CAT conditions (all items vs. DIF-excluded) were compared against a “true θ” estimated from a fixed-form test of 264 non-DIF items. Accuracy was evaluated using bias, root mean square error (RMSE), and correlation with true θ.
Results
In the CAT condition excluding DIF items, accuracy improved, with RMSE reduced and correlation with true θ increased. However, bias was slightly larger in magnitude. Gender-specific analyses showed that DIF removal reduced the underestimation of female ability but increased the underestimation of male ability, yielding estimates that were fairer across genders. When DIF items were included, estimation errors were more pronounced at both low and high ability levels.
Conclusion
Managing DIF in CAT-based high-stakes examinations can enhance fairness and precision. Using real examinee data, this study provides practical evidence of the implications of DIF for CAT-based measurement and supports fairness-oriented test design.

Performance of GPT-4o and o1-Pro on United Kingdom Medical Licensing Assessment-style items: a comparative study: Behrad Vakili, Aadam Ahmad, Mahsa Zolfaghari; J Educ Eval Health Prof. 2025;22:30. Published online October 10, 2025; DOI: https://doi.org/10.3352/jeehp.2025.22.30

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Abstract PDF Supplementary Material: Purpose
Large language models (LLMs) such as ChatGPT, and their potential to support autonomous learning for licensing exams like the UK Medical Licensing Assessment (UKMLA), are of growing interest. However, empirical evaluations of artificial intelligence (AI) performance against the UKMLA standard remain limited.
Methods
We evaluated the performance of 2 recent ChatGPT versions, GPT-4o and o1-Pro, on a curated set of 374 UKMLA-style single-best-answer items spanning diverse medical specialties. Statistical comparisons using McNemar’s test assessed the significance of differences between the 2 models. Specialties were analyzed to identify domain-specific variation. In addition, 20 image-based items were evaluated.
Results
GPT-4o achieved an accuracy of 88.8%, while o1-Pro achieved 93.0%. McNemar’s test revealed a statistically significant difference in favor of o1-Pro. Across specialties, both models demonstrated excellent performance in surgery, psychiatry, and infectious diseases. Notable differences arose in dermatology, respiratory medicine, and imaging, where o1-Pro consistently outperformed GPT-4o. Nevertheless, isolated weaknesses in general practice were observed. The analysis of image-based items showed 75% accuracy for GPT-4o and 90% for o1-Pro (P=0.25).
Conclusion
ChatGPT shows strong potential as an adjunct learning tool for UKMLA preparation, with both models achieving scores above the calculated pass mark. This underscores the promise of advanced AI models in medical education. However, specialty-specific inconsistencies suggest AI tools should complement, rather than replace, traditional study methods.

Performance of ChatGPT-4 on the French Board of Plastic Reconstructive and Aesthetic Surgery written exam: a descriptive study: Emma Dejean-Bouyer, Anoujat Kanlagna, François Thuau, Pierre Perrot, Ugo Lancien; J Educ Eval Health Prof. 2025;22:27. Published online September 30, 2025; DOI: https://doi.org/10.3352/jeehp.2025.22.27

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Abstract PDF Supplementary Material: Purpose
This study aims to evaluate the performance of Chat Generative Pre-Trained Transformer 4 (ChatGPT-4) on the French Board of Plastic, Reconstructive, and Aesthetic Surgery written examination and to assess its role as a supplementary resource in helping residents prepare for the qualification examination in plastic surgery.
Methods
This descriptive study evaluated ChatGPT-4’s performance on 213 items from the October 2024 French Board of Plastic, Reconstructive, and Aesthetic Surgery written examination. Responses were assessed for accuracy, logical reasoning, internal and external information use, and were categorized for fallacies by independent reviewers. Statistical analyses included chi-square tests and Fisher’s exact test for significance.
Results
ChatGPT-4 answered all questions across the 10 modules, achieving an overall accuracy rate of 77.5%. The model applied logical reasoning in 98.1% of the questions, utilized internal information in 94.4%, and incorporated external information in 91.1%.
Conclusion
ChatGPT-4 performs satisfactorily on the French Board of Plastic, Reconstructive, and Aesthetic Surgery written examination. Its accuracy met the minimum passing standards for the exam. While responses generally align with expected knowledge, careful verification remains necessary, particularly for questions involving image interpretation. As artificial intelligence continues to evolve, ChatGPT-4 is expected to become an increasingly reliable tool for medical education. At present, it remains a valuable resource for assisting plastic surgery residents in their training.

Decline in attrition rates in United States pediatric residency and fellowship programs, 2007–2020: a repeated cross-sectional study: Emma Omoruyi, Greg Russell, Kimberly Montez; J Educ Eval Health Prof. 2025;22:24. Published online September 5, 2025; DOI: https://doi.org/10.3352/jeehp.2025.22.24

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Abstract PDF Supplementary Material: Purpose
Declining fill rates in US pediatric residency and subspecialty programs requires trainee retention. Attrition, defined as transfers, withdrawals, dismissals, unsuccessful completions, or deaths, disrupts program function and impacts the pediatric workforce pipeline. It aims to evaluate attrition trends among pediatric residents and fellows in Accreditation Council for Graduate Medical Education (ACGME)-accredited programs from 2007 to 2020.
Methods
This repeated cross-sectional study analyzed publicly available ACGME Data Resource Book records. Attrition rates and 95% confidence intervals (CIs) were calculated overall and by subspecialty. Logistic regression assessed temporal changes; odds ratios (ORs) compared 2020 to 2007.
Results
From 2007–2020, pediatric residents increased from 8,145 to 9,419 and fellows from 2,875 to 4,279. Aggregate annual resident attrition averaged 1.71% (range, 0.93%–2.64%), and fellow attrition ranged from 12.39%–30.87%. Transfer rates declined from 18.05 to 5.20 per 1,000 trainees (P<0.0001), withdrawals from 5.65 to 2.76 (P=0.030), and dismissals from 3.14 in 2010 to 1.27 in 2020 (P=0.0068). Odds of unsuccessful completion significantly decreased in categorical pediatrics (OR, 0.41; 95% CI, 0.29–0.58), pediatric cardiology (OR, 0.08; 95% CI, 0.01–0.64), pediatric critical care (OR, 0.14; 95% CI, 0.06–0.35), and neonatal-perinatal medicine (OR, 0.46; 95% CI, 0.20–1.08).
Conclusion
Although attrition has improved, premature trainee loss can still disrupt program operations and threaten workforce development. Attrition may reflect educational environment quality, support structures, or selection processes. Greater data transparency is needed to understand demographic trends and inform equitable retention strategies, ultimately strengthening training programs and sustaining the United States pediatric workforce.

Performance of large language models on Thailand’s national medical licensing examination: a cross-sectional study: Prut Saowaprut, Romen Samuel Wabina, Junwei Yang, Lertboon Siriwat; J Educ Eval Health Prof. 2025;22:16. Published online May 12, 2025; DOI: https://doi.org/10.3352/jeehp.2025.22.16

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Abstract PDF Supplementary Material

Purpose
This study aimed to evaluate the feasibility of general-purpose large language models (LLMs) in addressing inequities in medical licensure exam preparation for Thailand’s National Medical Licensing Examination (ThaiNLE), which currently lacks standardized public study materials.
Methods
We assessed 4 multi-modal LLMs (GPT-4, Claude 3 Opus, Gemini 1.0/1.5 Pro) using a 304-question ThaiNLE Step 1 mock examination (10.2% image-based), applying deterministic API configurations and 5 inference repetitions per model. Performance was measured via micro- and macro-accuracy metrics compared against historical passing thresholds.
Results
All models exceeded passing scores, with GPT-4 achieving the highest accuracy (88.9%; 95% confidence interval, 88.7–89.1), surpassing Thailand’s national average by more than 2 standard deviations. Claude 3.5 Sonnet (80.1%) and Gemini 1.5 Pro (72.8%) followed hierarchically. Models demonstrated robustness across 17 of 20 medical domains, but variability was noted in genetics (74.0%) and cardiovascular topics (58.3%). While models demonstrated proficiency with images (Gemini 1.0 Pro: +9.9% vs. text), text-only accuracy remained superior (GPT-4o: 90.0% vs. 82.6%).
Conclusion
General-purpose LLMs show promise as equitable preparatory tools for ThaiNLE Step 1. However, domain-specific knowledge gaps and inconsistent multi-modal integration warrant refinement before clinical deployment.

Citations

Citations to this article as recorded by

Performance of GPT-4o and o1-Pro on United Kingdom Medical Licensing Assessment-style items: a comparative study
Behrad Vakili, Aadam Ahmad, Mahsa Zolfaghari
Journal of Educational Evaluation for Health Professions.2025; 22: 30. CrossRef
Large Language Models for the National Radiological Technologist Licensure Examination in Japan: Cross-Sectional Comparative Benchmarking and Evaluation of Model-Generated Items Study
Toshimune Ito, Toru Ishibashi, Tatsuya Hayashi, Shinya Kojima, Kazumi Sogabe
JMIR Medical Education.2025; 11: e81807. CrossRef
Technologies, opportunities, challenges, and future directions for integrating generative artificial intelligence into medical education: a narrative review
Junseok Kang, Jihyun Ahn
Ewha Medical Journal.2025; 48(4): e53. CrossRef

A nationwide survey on the curriculum and educational resources related to the Clinical Skills Test of the Korean Medical Licensing Examination: a cross-sectional descriptive study: Eun-Kyung Chung, Seok Hoon Kang, Do-Hoon Kim, MinJeong Kim, Ji-Hyun Seo, Keunmi Lee, Eui-Ryoung Han; J Educ Eval Health Prof. 2025;22:11. Published online March 13, 2025; DOI: https://doi.org/10.3352/jeehp.2025.22.11

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Abstract PDF Supplementary Material

Purpose
The revised Clinical Skills Test (CST) of the Korean Medical Licensing Exam aims to provide a better assessment of physicians’ clinical competence and ability to interact with patients. This study examined the impact of the revised CST on medical education curricula and resources nationwide, while also identifying areas for improvement within the revised CST.
Methods
This study surveyed faculty responsible for clinical clerkships at 40 medical schools throughout Korea to evaluate the status and changes in clinical skills education, assessment, and resources related to the CST. The researchers distributed the survey via email through regional consortia between December 7, 2023 and January 19, 2024.
Results
Nearly all schools implemented preliminary student–patient encounters during core clinical rotations. Schools primarily conducted clinical skills assessments in the third and fourth years, with a simplified form introduced in the first and second years. Remedial education was conducted through various methods, including one-on-one feedback from faculty after the assessment. All schools established clinical skills centers and made ongoing improvements. Faculty members did not perceive the CST revisions as significantly altering clinical clerkship or skills assessments. They suggested several improvements, including assessing patient records to improve accuracy and increasing the objectivity of standardized patient assessments to ensure fairness.
Conclusion
During the CST, students’ involvement in patient encounters and clinical skills education increased, improving the assessment and feedback processes for clinical skills within the curriculum. To enhance students’ clinical competencies and readiness, strengthening the validity and reliability of the CST is essential.

Citations

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Nationwide cross-sectional survey on the necessity of including a clinical skills assessment in the national licensure examination for Doctors of Korean Medicine
Aram Jeong, Eunbyul Cho, Chan-Young Kwon, Sanghoon Lee, Chungsik Cho, Sangwoo Shin, Min Hwangbo, Dong-Hyeon Kim, Hye-Yoon Lee
Medicine.2025; 104(45): e45366. CrossRef

Reliability and construct validation of the Blended Learning Usability Evaluation–Questionnaire with interprofessional clinicians in Canada: a methodological study: Anish Kumar Arora, Jeff Myers, Tavis Apramian, Kulamakan Kulasegaram, Daryl Bainbridge, Hsien Seow; J Educ Eval Health Prof. 2025;22:5. Published online January 16, 2025; DOI: https://doi.org/10.3352/jeehp.2025.22.5

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Abstract PDF Supplementary Material

Purpose
To generate Cronbach’s alpha and further mixed methods construct validity evidence for the Blended Learning Usability Evaluation–Questionnaire (BLUE-Q).
Methods
Forty interprofessional clinicians completed the BLUE-Q after finishing a 3-month long blended learning professional development program in Ontario, Canada. Reliability was assessed with Cronbach’s α for each of the 3 sections of the BLUE-Q and for all quantitative items together. Construct validity was evaluated through the Grand-Guillaume-Perrenoud et al. framework, which consists of 3 elements: congruence, convergence, and credibility. To compare quantitative and qualitative results, descriptive statistics, including means and standard deviations for each Likert scale item of the BLUE-Q were calculated.
Results
Cronbach’s α was 0.95 for the pedagogical usability section, 0.85 for the synchronous modality section, 0.93 for the asynchronous modality section, and 0.96 for all quantitative items together. Mean ratings (with standard deviations) were 4.77 (0.506) for pedagogy, 4.64 (0.654) for synchronous learning, and 4.75 (0.536) for asynchronous learning. Of the 239 qualitative comments received, 178 were identified as substantive, of which 88% were considered congruent and 79% were considered convergent with the high means. Among all congruent responses, 69% were considered confirming statements and 31% were considered clarifying statements, suggesting appropriate credibility. Analysis of the clarifying statements assisted in identifying 5 categories of suggestions for program improvement.
Conclusion
The BLUE-Q demonstrates high reliability and appropriate construct validity in the context of a blended learning program with interprofessional clinicians, making it a valuable tool for comprehensive program evaluation, quality improvement, and evaluative research in health professions education.

Citations

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Utilizing cognitive interview in the item refinement of the Blended Teaching Assessment Tool (BTAT) for Health Professions Education
Maria Teresita B. Dalusong, Glenda Sanggalang Ogerio, Valentin C. Dones, Maria Elizabeth M. Grageda
Philippine Journal of Health Research and Development.2025; 29(2): 54. CrossRef
All providers Better Communication Skills (ABCs) program: protocol for a randomized controlled trial assessing communication training effectiveness with interprofessional clinicians
Hsien Seow, Anish K. Arora, Daryl Bainbridge, Zhimeng Jia, Leah Steinberg, Nadia Incardona, Oren Levine, Justin J. Sanders, Jessica Simon, Amanda Roze des Ordons, Karen Zhang, Jeff Myers
BMC Palliative Care.2025;[Epub] CrossRef

Empathy and tolerance of ambiguity in medical students and doctors participating in art-based observational training at the Rijksmuseum in Amsterdam, the Netherlands: a before-and-after study: Stella Anna Bult, Thomas van Gulik; J Educ Eval Health Prof. 2025;22:3. Published online January 14, 2025; DOI: https://doi.org/10.3352/jeehp.2025.22.3

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Abstract PDF Supplementary Material

Purpose
This research presents an experimental study using validated questionnaires to quantitatively assess the outcomes of art-based observational training in medical students, residents, and specialists. The study tested the hypothesis that art-based observational training would lead to measurable effects on judgement skills (tolerance of ambiguity) and empathy in medical students and doctors.
Methods
An experimental cohort study with pre- and post-intervention assessments was conducted using validated questionnaires and qualitative evaluation forms to examine the outcomes of art-based observational training in medical students and doctors. Between December 2023 and June 2024, 15 art courses were conducted in the Rijksmuseum in Amsterdam. Participants were assessed on empathy using the Jefferson Scale of Empathy (JSE) and tolerance of ambiguity using the Tolerance of Ambiguity in Medical Students and Doctors (TAMSAD) scale.
Results
In total, 91 participants were included; 29 participants completed the JSE and 62 completed the TAMSAD scales. The results showed statistically significant post-test increases for mean JSE and TAMSAD scores (3.71 points for the JSE, ranging from 20 to 140, and 1.86 points for the TAMSAD, ranging from 0 to 100). The qualitative findings were predominantly positive.
Conclusion
The results suggest that incorporating art-based observational training in medical education improves empathy and tolerance of ambiguity. This study highlights the importance of art-based observational training in medical education in the professional development of medical students and doctors.

Citations

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Observational training for surgical residents using visual arts in the museum
Thomas M. van Gulik, Stella A. Bult, Pien E.J. de Ruiter, Floortje Huizing, Alexander de Mol van Otterloo, Alexander Leijdesdorff, Sjoerd Lagarde
Surgery.2026; 190: 109843. CrossRef
Developing a Feasible Arts and Humanities Course Using Visual Thinking Strategies and Haiku Writing: A Mixed-Methods Study
Hirohisa Fujikawa, Takayuki Ando, Junji Haruta
Medical Science Educator.2025;[Epub] CrossRef
Understanding uncertainty and ambiguity in medicine and medical education: a narrative review with implications for training
Sarine Sarkis, Christian Raphael
Postgraduate Medical Journal.2025;[Epub] CrossRef

Inter-rater reliability and content validity of the measurement tool for portfolio assessments used in the Introduction to Clinical Medicine course at Ewha Womans University College of Medicine: a methodological study: Dong-Mi Yoo, Jae Jin Han; J Educ Eval Health Prof. 2024;21:39. Published online December 10, 2024; DOI: https://doi.org/10.3352/jeehp.2024.21.39

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Abstract PDF Supplementary Material

Purpose
This study aimed to examine the reliability and validity of a measurement tool for portfolio assessments in medical education. Specifically, it investigated scoring consistency among raters and assessment criteria appropriateness according to an expert panel.
Methods
A cross-sectional observational study was conducted from September to December 2018 for the Introduction to Clinical Medicine course at the Ewha Womans University College of Medicine. Data were collected for 5 randomly selected portfolios scored by a gold-standard rater and 6 trained raters. An expert panel assessed the validity of 12 assessment items using the content validity index (CVI). Statistical analysis included Pearson correlation coefficients for rater alignment, the intraclass correlation coefficient (ICC) for inter-rater reliability, and the CVI for item-level validity.
Results
Rater 1 had the highest Pearson correlation (0.8916) with the gold-standard rater, while Rater 5 had the lowest (0.4203). The ICC for all raters was 0.3821, improving to 0.4415 after excluding Raters 1 and 5, indicating a 15.6% reliability increase. All assessment items met the CVI threshold of ≥0.75, with some achieving a perfect score (CVI=1.0). However, items like “sources” and “level and degree of performance” showed lower validity (CVI=0.72).
Conclusion
The present measurement tool for portfolio assessments demonstrated moderate reliability and strong validity, supporting its use as a credible tool. For a more reliable portfolio assessment, more faculty training is needed.

Citations

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On the quantitative analysis of assessment scores with implicit and explicit constraints
Sanjeeb Shrestha, Xiaoying Kong, Paul Kwan
Studies in Educational Evaluation.2025; 87: 101509. CrossRef

History article

History of the medical licensure system in Korea from the late 1800s to 1992: Sang-Ik Hwang; J Educ Eval Health Prof. 2024;21:36. Published online December 9, 2024; DOI: https://doi.org/10.3352/jeehp.2024.21.36

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Abstract PDF Supplementary Material: The introduction of modern Western medicine in the late 19th century, notably through vaccination initiatives, marked the beginning of governmental involvement in medical licensure, with the licensing of doctors who performed vaccinations. The establishment of the national medical school “Euihakkyo” in 1899 further formalized medical education and licensure, granting graduates the privilege to practice medicine without additional examinations. The enactment of the Regulations on Doctors in 1900 by the Joseon government aimed to define doctor qualifications, including modern and traditional practitioners, comprehensively. However, resistance from the traditional medical community hindered its full implementation. During the Japanese colonial occupation of the Korean Peninsula from 1910 to 1945, the medical licensure system was controlled by colonial authorities, leading to the marginalization of traditional Korean medicine and the imposition of imperial hierarchical structures. Following liberation in 1945 from Japanese colonial rule, the Korean government undertook significant reforms, culminating in the National Medical Law, which was enacted in 1951. This law redefined doctor qualifications and reinstated the status of traditional Korean medicine. The introduction of national examinations for physicians increased state involvement in ensuring medical competence. The privatization of the Korean Medical Licensing Examination led to the establishment of the Korea Health Personnel Licensing Examination Institute in 1992, which assumed responsibility for administering licensing examinations for all healthcare workers. This shift reflected a move towards specialized management of professional standards. The evolution of the medical licensure system in Korea illustrates a dynamic process shaped by the historical context, balancing the protection of public health with the rights of medical practitioners.

Research articles

Validation of the Blended Learning Usability Evaluation–Questionnaire (BLUE-Q) through an innovative Bayesian questionnaire validation approach: Anish Kumar Arora, Charo Rodriguez, Tamara Carver, Hao Zhang, Tibor Schuster; J Educ Eval Health Prof. 2024;21:31. Published online November 7, 2024; DOI: https://doi.org/10.3352/jeehp.2024.21.31

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Abstract PDF Supplementary Material

Purpose
The primary aim of this study is to validate the Blended Learning Usability Evaluation–Questionnaire (BLUE-Q) for use in the field of health professions education through a Bayesian approach. As Bayesian questionnaire validation remains elusive, a secondary aim of this article is to serve as a simplified tutorial for engaging in such validation practices in health professions education.
Methods
A total of 10 health education-based experts in blended learning were recruited to participate in a 30-minute interviewer-administered survey. On a 5-point Likert scale, experts rated how well they perceived each item of the BLUE-Q to reflect its underlying usability domain (i.e., effectiveness, efficiency, satisfaction, accessibility, organization, and learner experience). Ratings were descriptively analyzed and converted into beta prior distributions. Participants were also given the option to provide qualitative comments for each item.
Results
After reviewing the computed expert prior distributions, 31 quantitative items were identified as having a probability of “low endorsement” and were thus removed from the questionnaire. Additionally, qualitative comments were used to revise the phrasing and order of items to ensure clarity and logical flow. The BLUE-Q’s final version comprises 23 Likert-scale items and 6 open-ended items.
Conclusion
Questionnaire validation can generally be a complex, time-consuming, and costly process, inhibiting many from engaging in proper validation practices. In this study, we demonstrate that a Bayesian questionnaire validation approach can be a simple, resource-efficient, yet rigorous solution to validating a tool for content and item-domain correlation through the elicitation of domain expert endorsement ratings.

Citations

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Reliability and construct validation of the Blended Learning Usability Evaluation–Questionnaire with interprofessional clinicians in Canada: a methodological study
Anish Kumar Arora, Jeff Myers, Tavis Apramian, Kulamakan Kulasegaram, Daryl Bainbridge, Hsien Seow
Journal of Educational Evaluation for Health Professions.2025; 22: 5. CrossRef
Utilizing cognitive interview in the item refinement of the Blended Teaching Assessment Tool (BTAT) for Health Professions Education
Maria Teresita B. Dalusong, Glenda Sanggalang Ogerio, Valentin C. Dones, Maria Elizabeth M. Grageda
Philippine Journal of Health Research and Development.2025; 29(2): 54. CrossRef
All providers Better Communication Skills (ABCs) program: protocol for a randomized controlled trial assessing communication training effectiveness with interprofessional clinicians
Hsien Seow, Anish K. Arora, Daryl Bainbridge, Zhimeng Jia, Leah Steinberg, Nadia Incardona, Oren Levine, Justin J. Sanders, Jessica Simon, Amanda Roze des Ordons, Karen Zhang, Jeff Myers
BMC Palliative Care.2025;[Epub] CrossRef

Performance of GPT-3.5 and GPT-4 on standardized urology knowledge assessment items in the United States: a descriptive study: Max Samuel Yudovich, Elizaveta Makarova, Christian Michael Hague, Jay Dilip Raman; J Educ Eval Health Prof. 2024;21:17. Published online July 8, 2024; DOI: https://doi.org/10.3352/jeehp.2024.21.17

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Abstract PDF Supplementary Material

Purpose
This study aimed to evaluate the performance of Chat Generative Pre-Trained Transformer (ChatGPT) with respect to standardized urology multiple-choice items in the United States.
Methods
In total, 700 multiple-choice urology board exam-style items were submitted to GPT-3.5 and GPT-4, and responses were recorded. Items were categorized based on topic and question complexity (recall, interpretation, and problem-solving). The accuracy of GPT-3.5 and GPT-4 was compared across item types in February 2024.
Results
GPT-4 answered 44.4% of items correctly compared to 30.9% for GPT-3.5 (P<0.00001). GPT-4 (vs. GPT-3.5) had higher accuracy with urologic oncology (43.8% vs. 33.9%, P=0.03), sexual medicine (44.3% vs. 27.8%, P=0.046), and pediatric urology (47.1% vs. 27.1%, P=0.012) items. Endourology (38.0% vs. 25.7%, P=0.15), reconstruction and trauma (29.0% vs. 21.0%, P=0.41), and neurourology (49.0% vs. 33.3%, P=0.11) items did not show significant differences in performance across versions. GPT-4 also outperformed GPT-3.5 with respect to recall (45.9% vs. 27.4%, P<0.00001), interpretation (45.6% vs. 31.5%, P=0.0005), and problem-solving (41.8% vs. 34.5%, P=0.56) type items. This difference was not significant for the higher-complexity items.
Conclusions
ChatGPT performs relatively poorly on standardized multiple-choice urology board exam-style items, with GPT-4 outperforming GPT-3.5. The accuracy was below the proposed minimum passing standards for the American Board of Urology’s Continuing Urologic Certification knowledge reinforcement activity (60%). As artificial intelligence progresses in complexity, ChatGPT may become more capable and accurate with respect to board examination items. For now, its responses should be scrutinized.

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Evaluating the Performance of ChatGPT4.0 Versus ChatGPT3.5 on the Hand Surgery Self-Assessment Exam: A Comparative Analysis of Performance on Image-Based Questions
Kiera L Vrindten, Megan Hsu, Yuri Han, Brian Rust, Heili Truumees, Brian M Katt
Cureus.2025;[Epub] CrossRef
Assessing the performance of large language models (GPT-3.5 and GPT-4) and accurate clinical information for pediatric nephrology
Nadide Melike Sav
Pediatric Nephrology.2025; 40(9): 2879. CrossRef
Retrieval-augmented generation enhances large language model performance on the Japanese orthopedic board examination
Juntaro Maruyama, Satoshi Maki, Takeo Furuya, Yuki Nagashima, Kyota Kitagawa, Yasunori Toki, Shuhei Iwata, Megumi Yazaki, Takaki Kitamura, Sho Gushiken, Yuji Noguchi, Masataka Miura, Masahiro Inoue, Yasuhiro Shiga, Kazuhide Inage, Sumihisa Orita, Seiji Oh
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Educational/Faculty development material

The 6 degrees of curriculum integration in medical education in the United States: Julie Youm, Jennifer Christner, Kevin Hittle, Paul Ko, Cinda Stone, Angela D. Blood, Samara Ginzburg; J Educ Eval Health Prof. 2024;21:15. Published online June 13, 2024; DOI: https://doi.org/10.3352/jeehp.2024.21.15

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Abstract PDF Supplementary Material

Despite explicit expectations and accreditation requirements for integrated curriculum, there needs to be more clarity around an accepted common definition, best practices for implementation, and criteria for successful curriculum integration. To address the lack of consensus surrounding integration, we reviewed the literature and herein propose a definition for curriculum integration for the medical education audience. We further believe that medical education is ready to move beyond “horizontal” (1-dimensional) and “vertical” (2-dimensional) integration and propose a model of “6 degrees of curriculum integration” to expand the 2-dimensional concept for future designs of medical education programs and best prepare learners to meet the needs of patients. These 6 degrees include: interdisciplinary, timing and sequencing, instruction and assessment, incorporation of basic and clinical sciences, knowledge and skills-based competency progression, and graduated responsibilities in patient care. We encourage medical educators to look beyond 2-dimensional integration to this holistic and interconnected representation of curriculum integration.

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Noor Fatima, Mehran Ullah Bani, Fazal Ur Rehman, Mansoor Ali Yazdan Khan, Mubeen Sultan, Nosheen Mehsood, Ubaid Ullah, Zia Ul Haq
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Research articles

Redesigning a faculty development program for clinical teachers in Indonesia: a before-and-after study: Rita Mustika, Nadia Greviana, Dewi Anggraeni Kusumoningrum, Anyta Pinasthika; J Educ Eval Health Prof. 2024;21:14. Published online June 13, 2024; DOI: https://doi.org/10.3352/jeehp.2024.21.14

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357 Download
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Abstract PDF Supplementary Material

Purpose
Faculty development (FD) is important to support teaching, including for clinical teachers. Faculty of Medicine Universitas Indonesia (FMUI) has conducted a clinical teacher training program developed by the medical education department since 2008, both for FMUI teachers and for those at other centers in Indonesia. However, participation is often challenging due to clinical, administrative, and research obligations. The coronavirus disease 2019 pandemic amplified the urge to transform this program. This study aimed to redesign and evaluate an FD program for clinical teachers that focuses on their needs and current situation.
Methods
A 5-step design thinking framework (empathizing, defining, ideating, prototyping, and testing) was used with a pre/post-test design. Design thinking made it possible to develop a participant-focused program, while the pre/post-test design enabled an assessment of the program’s effectiveness.
Results
Seven medical educationalists and 4 senior and 4 junior clinical teachers participated in a group discussion in the empathize phase of design thinking. The research team formed a prototype of a 3-day blended learning course, with an asynchronous component using the Moodle learning management system and a synchronous component using the Zoom platform. Pre-post-testing was done in 2 rounds, with 107 and 330 participants, respectively. Evaluations of the first round provided feedback for improving the prototype for the second round.
Conclusion
Design thinking enabled an innovative-creative process of redesigning FD that emphasized participants’ needs. The pre/post-testing showed that the program was effective. Combining asynchronous and synchronous learning expands access and increases flexibility. This approach could also apply to other FD programs.

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Dongyu Wang, Yanan Deng, Lan Zeng, Lixia Dong, Ruben Martin Payo, Fengying Zhang
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Challenges and potential improvements in the Accreditation Standards of the Korean Institute of Medical Education and Evaluation 2019 (ASK2019) derived through meta-evaluation: a cross-sectional study: Yoonjung Lee, Min-jung Lee, Junmoo Ahn, Chungwon Ha, Ye Ji Kang, Cheol Woong Jung, Dong-Mi Yoo, Jihye Yu, Seung-Hee Lee; J Educ Eval Health Prof. 2024;21:8. Published online April 2, 2024; DOI: https://doi.org/10.3352/jeehp.2024.21.8

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Abstract PDF Supplementary Material

Purpose
This study aimed to identify challenges and potential improvements in Korea's medical education accreditation process according to the Accreditation Standards of the Korean Institute of Medical Education and Evaluation 2019 (ASK2019). Meta-evaluation was conducted to survey the experiences and perceptions of stakeholders, including self-assessment committee members, site visit committee members, administrative staff, and medical school professors.
Methods
A cross-sectional study was conducted using surveys sent to 40 medical schools. The 332 participants included self-assessment committee members, site visit team members, administrative staff, and medical school professors. The t-test, one-way analysis of variance and the chi-square test were used to analyze and compare opinions on medical education accreditation between the categories of participants.
Results
Site visit committee members placed greater importance on the necessity of accreditation than faculty members. A shared positive view on accreditation’s role in improving educational quality was seen among self-evaluation committee members and professors. Administrative staff highly regarded the Korean Institute of Medical Education and Evaluation’s reliability and objectivity, unlike the self-evaluation committee members. Site visit committee members positively perceived the clarity of accreditation standards, differing from self-assessment committee members. Administrative staff were most optimistic about implementing standards. However, the accreditation process encountered challenges, especially in duplicating content and preparing self-evaluation reports. Finally, perceptions regarding the accuracy of final site visit reports varied significantly between the self-evaluation committee members and the site visit committee members.
Conclusion
This study revealed diverse views on medical education accreditation, highlighting the need for improved communication, expectation alignment, and stakeholder collaboration to refine the accreditation process and quality.

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Sun Huh
The Ewha Medical Journal.2024;[Epub] CrossRef

Review

Opportunities, challenges, and future directions of large language models, including ChatGPT in medical education: a systematic scoping review: Xiaojun Xu, Yixiao Chen, Jing Miao; J Educ Eval Health Prof. 2024;21:6. Published online March 15, 2024; DOI: https://doi.org/10.3352/jeehp.2024.21.6

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Abstract PDF Supplementary Material

Background
ChatGPT is a large language model (LLM) based on artificial intelligence (AI) capable of responding in multiple languages and generating nuanced and highly complex responses. While ChatGPT holds promising applications in medical education, its limitations and potential risks cannot be ignored.
Methods
A scoping review was conducted for English articles discussing ChatGPT in the context of medical education published after 2022. A literature search was performed using PubMed/MEDLINE, Embase, and Web of Science databases, and information was extracted from the relevant studies that were ultimately included.
Results
ChatGPT exhibits various potential applications in medical education, such as providing personalized learning plans and materials, creating clinical practice simulation scenarios, and assisting in writing articles. However, challenges associated with academic integrity, data accuracy, and potential harm to learning were also highlighted in the literature. The paper emphasizes certain recommendations for using ChatGPT, including the establishment of guidelines. Based on the review, 3 key research areas were proposed: cultivating the ability of medical students to use ChatGPT correctly, integrating ChatGPT into teaching activities and processes, and proposing standards for the use of AI by medical students.
Conclusion
ChatGPT has the potential to transform medical education, but careful consideration is required for its full integration. To harness the full potential of ChatGPT in medical education, attention should not only be given to the capabilities of AI but also to its impact on students and teachers.

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Research articles

Negative effects on medical students’ scores for clinical performance during the COVID-19 pandemic in Taiwan: a comparative study: Eunice Jia-Shiow Yuan, Shiau-Shian Huang, Chia-An Hsu, Jiing-Feng Lirng, Tzu-Hao Li, Chia-Chang Huang, Ying-Ying Yang, Chung-Pin Li, Chen-Huan Chen; J Educ Eval Health Prof. 2023;20:37. Published online December 26, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.37

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Abstract PDF Supplementary Material

Purpose
Coronavirus disease 2019 (COVID-19) has heavily impacted medical clinical education in Taiwan. Medical curricula have been altered to minimize exposure and limit transmission. This study investigated the effect of COVID-19 on Taiwanese medical students’ clinical performance using online standardized evaluation systems and explored the factors influencing medical education during the pandemic.
Methods
Medical students were scored from 0 to 100 based on their clinical performance from 1/1/2018 to 6/31/2021. The students were placed into pre-COVID-19 (before 2/1/2020) and midst-COVID-19 (on and after 2/1/2020) groups. Each group was further categorized into COVID-19-affected specialties (pulmonary, infectious, and emergency medicine) and other specialties. Generalized estimating equations (GEEs) were used to compare and examine the effects of relevant variables on student performance.
Results
In total, 16,944 clinical scores were obtained for COVID-19-affected specialties and other specialties. For the COVID-19-affected specialties, the midst-COVID-19 score (88.513.52) was significantly lower than the pre-COVID-19 score (90.143.55) (P<0.0001). For the other specialties, the midst-COVID-19 score (88.323.68) was also significantly lower than the pre-COVID-19 score (90.063.58) (P<0.0001). There were 1,322 students (837 males and 485 females). Male students had significantly lower scores than female students (89.333.68 vs. 89.993.66, P=0.0017). GEE analysis revealed that the COVID-19 pandemic (unstandardized beta coefficient=-1.99, standard error [SE]=0.13, P<0.0001), COVID-19-affected specialties (B=0.26, SE=0.11, P=0.0184), female students (B=1.10, SE=0.20, P<0.0001), and female attending physicians (B=-0.19, SE=0.08, P=0.0145) were independently associated with students’ scores.
Conclusion
COVID-19 negatively impacted medical students' clinical performance, regardless of their specialty. Female students outperformed male students, irrespective of the pandemic.

Citations

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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 Supplementary Material

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.

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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.

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Carlos Andres Colunga Tinajero
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Reliability of ChatGPT-4o in analysing medical data: a test case study on patients at risk for limb amputation
Liat Toderis, Iris Reychav, Roger McHaney, Bernice Oberman, Chen Speter, Ronen Loebstein
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Statistical analysis using ChatGPT in medical research
Soo-Nyung Kim
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Xiaojun Xu, Yixiao Chen, Jing Miao
Journal of Educational Evaluation for Health Professions.2024; 21: 6. CrossRef
Comparing the Performance of ChatGPT-4 and Medical Students on MCQs at Varied Levels of Bloom’s Taxonomy
Ambadasu Bharatha, Nkemcho Ojeh, Ahbab Mohammad Fazle Rabbi, Michael Campbell, Kandamaran Krishnamurthy, Rhaheem Layne-Yarde, Alok Kumar, Dale Springer, Kenneth Connell, Md Anwarul Majumder
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Abhijit Bhattaru, Naveena Yanamala, Partho P. Sengupta
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Alexandra Aster, Matthias Carl Laupichler, Tamina Rockwell-Kollmann, Gilda Masala, Ebru Bala, Tobias Raupach
Medical Science Educator.2024; 35(1): 555. CrossRef
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Urs Alexander Fichtner, Jochen Knaus, Erika Graf, Georg Koch, Jörg Sahlmann, Dominikus Stelzer, Martin Wolkewitz, Harald Binder, Susanne Weber, Bekalu Tadesse Moges
PLOS ONE.2024; 19(12): e0308375. CrossRef

Brief report

Comparing ChatGPT’s ability to rate the degree of stereotypes and the consistency of stereotype attribution with those of medical students in New Zealand in developing a similarity rating test: a methodological study: Chao-Cheng Lin, Zaine Akuhata-Huntington, Che-Wei Hsu; J Educ Eval Health Prof. 2023;20:17. Published online June 12, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.17

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Abstract PDF Supplementary Material

Learning about one’s implicit bias is crucial for improving one’s cultural competency and thereby reducing health inequity. To evaluate bias among medical students following a previously developed cultural training program targeting New Zealand Māori, we developed a text-based, self-evaluation tool called the Similarity Rating Test (SRT). The development process of the SRT was resource-intensive, limiting its generalizability and applicability. Here, we explored the potential of ChatGPT, an automated chatbot, to assist in the development process of the SRT by comparing ChatGPT’s and students’ evaluations of the SRT. Despite results showing non-significant equivalence and difference between ChatGPT’s and students’ ratings, ChatGPT’s ratings were more consistent than students’ ratings. The consistency rate was higher for non-stereotypical than for stereotypical statements, regardless of rater type. Further studies are warranted to validate ChatGPT’s potential for assisting in SRT development for implementation in medical education and evaluation of ethnic stereotypes and related topics.

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Development and validation of a GPT-based rater for assessing communication skills using the Gap-Kalamazoo Communication Skills Assessment Form
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Medical Teacher.2026; 48(1): 93. CrossRef
Generative artificial intelligence in mental health: A preliminary study on automating materials development for cognitive bias modification
Che-Wei Hsu, Mia Cochrane, Sasini Bambarawana
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Applications of Artificial Intelligence in Medical Education: A Systematic Review
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One year in the classroom with ChatGPT: empirical insights and transformative impacts
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Research articles

Relationships between undergraduate medical students’ attitudes toward communication skills learning and demographics in Zambia: a survey-based descriptive study: Mercy Ijeoma Okwudili Ezeala, John Volk; J Educ Eval Health Prof. 2023;20:16. Published online June 1, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.16

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Abstract PDF Supplementary Material

Purpose
This study aimed to detect relationships between undergraduate students’ attitudes toward communication skills learning and demographic variables (such as age, academic year, and gender). Understanding these relationships could provide information for communication skills facilitators and curriculum planners on structuring course delivery and integrating communication skills training into the medical curriculum.
Methods
The descriptive study involved a survey of 369 undergraduate students from 2 medical schools in Zambia who participated in communication skills training stratified by academic year using the Communication Skills Attitude Scale. Data were collected between October and December 2021 and analyzed using IBM SPSS for Windows version 28.0.
Results
One-way analysis of variance revealed a significant difference in attitude between at least 5 academic years. There was a significant difference in attitudes between the 2nd and 5th academic years (t=5.95, P˂0.001). No significant difference in attitudes existed among the academic years on the negative subscale; the 2nd and 3rd (t=3.82, P=0.004), 4th (t=3.61, P=0.011), 5th (t=8.36, P˂0.001), and 6th (t=4.20, P=0.001) academic years showed significant differences on the positive subscale. Age showed no correlation with attitudes. There was a more favorable attitude to learning communication skills among the women participants than among the men participants (P=0.006).
Conclusion
Despite positive general attitudes toward learning communication skills, the difference in attitude between the genders, academic years 2 and 5, and the subsequent classes suggest a re-evaluation of the curriculum and teaching methods to facilitate appropriate course structure according to the academic years and a learning process that addressees gender differences.

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Assessing the Impact of a Prescription Communication Skills Training Module on the Attitudes and Competency of Medical Undergraduates
Padmanabha Thiruganahalli Shivaraju, Ravi Shankar Manchukonda, Tejaswi H Lokanathan, Haradanahalli G Kshamaa
Cureus.2025;[Epub] CrossRef
Mobile gamification in pharmacy education: A comparative study of learning outcomes and perceptions across gender
C. Piquer-Martinez, A. Gonzalez-Salgado, M.I. Valverde-Merino, M.J. Zarzuelo, M. Gomez-Guzman
Currents in Pharmacy Teaching and Learning.2025; 17(12): 102480. CrossRef
Attitudes toward learning communication skills among Iranian medical students
Naser Yousefzadeh Kandevani, Ali Labaf, Azim Mirzazadeh, Pegah Salimi Pormehr
BMC Medical Education.2024;[Epub] CrossRef

Students’ performance of and perspective on an objective structured practical examination for the assessment of preclinical and practical skills in biomedical laboratory science students in Sweden: a 5-year longitudinal study: Catharina Hultgren, Annica Lindkvist, Sophie Curbo, Maura Heverin; J Educ Eval Health Prof. 2023;20:13. Published online April 6, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.13

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165 Download
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Abstract PDF Supplementary Material

Purpose
It aims to find students’ performance of and perspectives on an objective structured practical examination (OSPE) for assessment of laboratory and preclinical skills in biomedical laboratory science (BLS). It also aims to investigate the perception, acceptability, and usefulness of OSPE from the students’ and examiners’ point of view.
Methods
This was a longitudinal study to implement an OSPE in BLS. The student group consisted of 198 BLS students enrolled in semester 4, 2015–2019 at Karolinska University Hospital Huddinge, Sweden. Fourteen teachers evaluated the performance by completing a checklist and global rating scales. A student survey questionnaire was administered to the participants to evaluate the student perspective. To assess quality, 4 independent observers were included to monitor the examiners.
Results
Almost 50% of the students passed the initial OSPE. During the repeat OSPE, 73% of the students passed the OSPE. There was a statistically significant difference between the first and the second repeat OSPE (P<0.01) but not between the first and the third attempt (P=0.09). The student survey questionnaire was completed by 99 of the 198 students (50%) and only 63 students responded to the free-text questions (32%). According to these responses, some stations were perceived as more difficult, albeit they considered the assessment to be valid. The observers found the assessment protocols and examiner’s instructions assured the objectivity of the examination.
Conclusion
The introduction of an OSPE in the education of biomedical laboratory scientists was a reliable, and useful examination of practical skills.

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Unlocking learning: exploring take-home examinations and viva voce examinations in microbiology education for biomedical laboratory science students
Sophie Curbo, Annica Lindkvist, Catharina Hultgren, Jorge Cervantes
Journal of Microbiology & Biology Education.2025;[Epub] CrossRef

Review

Factors associated with medical students’ scores on the National Licensing Exam in Peru: a systematic review: Javier Alejandro Flores-Cohaila; J Educ Eval Health Prof. 2022;19:38. Published online December 29, 2022; DOI: https://doi.org/10.3352/jeehp.2022.19.38

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385 Download
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Abstract PDF Supplementary Material

Purpose
This study aimed to identify factors that have been studied for their associations with National Licensing Examination (ENAM) scores in Peru.
Methods
A search was conducted of literature databases and registers, including EMBASE, SciELO, Web of Science, MEDLINE, Peru’s National Register of Research Work, and Google Scholar. The following key terms were used: “ENAM” and “associated factors.” Studies in English and Spanish were included. The quality of the included studies was evaluated using the Medical Education Research Study Quality Instrument (MERSQI).
Results
In total, 38,500 participants were enrolled in 12 studies. Most (11/12) studies were cross-sectional, except for one case-control study. Three studies were published in peer-reviewed journals. The mean MERSQI was 10.33. A better performance on the ENAM was associated with a higher-grade point average (GPA) (n=8), internship setting in EsSalud (n=4), and regular academic status (n=3). Other factors showed associations in various studies, such as medical school, internship setting, age, gender, socioeconomic status, simulations test, study resources, preparation time, learning styles, study techniques, test-anxiety, and self-regulated learning strategies.
Conclusion
The ENAM is a multifactorial phenomenon; our model gives students a locus of control on what they can do to improve their score (i.e., implement self-regulated learning strategies) and faculty, health policymakers, and managers a framework to improve the ENAM score (i.e., design remediation programs to improve GPA and integrate anxiety-management courses into the curriculum).

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Peruvian medical residency selection: a portrayal of scores, distribution, and predictors of 28,872 applicants between 2019 and 2023
Javier A. Flores-Cohaila, Brayan Miranda-Chavez, Cesar Copaja-Corzo, Xiomara C. Benavente-Chalco, Wagner Rios-García, Vanessa P. Moreno-Ccama, Angel Samanez-Obeso, Marco Rivarola-Hidalgo
BMC Medical Education.2025;[Epub] CrossRef
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Franco Romaní, César Gutiérrez
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Performance of ChatGPT on the Peruvian National Licensing Medical Examination: Cross-Sectional Study
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JMIR Medical Education.2023; 9: e48039. CrossRef

Educational/Faculty development material

Common models and approaches for the clinical educator to plan effective feedback encounters: Cesar Orsini, Veena Rodrigues, Jorge Tricio, Margarita Rosel; J Educ Eval Health Prof. 2022;19:35. Published online December 19, 2022; DOI: https://doi.org/10.3352/jeehp.2022.19.35

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1,891 Download
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Abstract PDF Supplementary Material

Giving constructive feedback is crucial for learners to bridge the gap between their current performance and the desired standards of competence. Giving effective feedback is a skill that can be learned, practiced, and improved. Therefore, our aim was to explore models in clinical settings and assess their transferability to different clinical feedback encounters. We identified the 6 most common and accepted feedback models, including the Feedback Sandwich, the Pendleton Rules, the One-Minute Preceptor, the SET-GO model, the R2C2 (Rapport/Reaction/Content/Coach), and the ALOBA (Agenda Led Outcome-based Analysis) model. We present a handy resource describing their structure, strengths and weaknesses, requirements for educators and learners, and suitable feedback encounters for use for each model. These feedback models represent practical frameworks for educators to adopt but also to adapt to their preferred style, combining and modifying them if necessary to suit their needs and context.

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Research articles

Possibility of independent use of the yes/no Angoff and Hofstee methods for the standard setting of the Korean Medical Licensing Examination written test: a descriptive study: Do-Hwan Kim, Ye Ji Kang, Hoon-Ki Park; J Educ Eval Health Prof. 2022;19:33. Published online December 12, 2022; DOI: https://doi.org/10.3352/jeehp.2022.19.33

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Abstract PDF Supplementary Material

Purpose
This study aims to apply the yes/no Angoff and Hofstee methods to actual Korean Medical Licensing Examination (KMLE) 2022 written examination data to estimate cut scores for the written KMLE.
Methods
Fourteen panelists gathered to derive the cut score of the 86th KMLE written examination data using the yes/no Angoff method. The panel reviewed the items individually before the meeting and shared their respective understanding of the minimum-competency physician. The standard setting process was conducted in 5 rounds over a total of 800 minutes. In addition, 2 rounds of the Hofstee method were conducted before starting the standard setting process and after the second round of yes/no Angoff.
Results
For yes/no Angoff, as each round progressed, the panel’s opinion gradually converged to a cut score of 198 points, and the final passing rate was 95.1%. The Hofstee cut score was 208 points out of a maximum 320 with a passing rate of 92.1% at the first round. It scored 204 points with a passing rate of 93.3% in the second round.
Conclusion
The difference between the cut scores obtained through yes/no Angoff and Hofstee methods did not exceed 2% points, and they were within the range of cut scores from previous studies. In both methods, the difference between the panelists decreased as rounds were repeated. Overall, our findings suggest the acceptability of cut scores and the possibility of independent use of both methods.

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Angoff methods in standard setting in health professional education: a systematic review and meta-analysis
Kannan Sridharan, Gowri Sivaramakrishnan
BMC Medical Education.2025;[Epub] CrossRef
Standard setting methods in objective structured clinical examination (OSCE): A comparative study of five methods
Reshma Ansari, Norhafizah Ab Manan, Nur Ain Mahat, Norfaizatul Shalida Omar, Atikah Abdul Latiff, Sara Idris, Azli Shahril Othman
Journal of Medical Education Development.2024; 17(56): 87. CrossRef
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Presidential address: improving item validity and adopting computer-based testing, clinical skills assessments, artificial intelligence, and virtual reality in health professions licensing examinations in Korea
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Journal of Educational Evaluation for Health Professions.2023; 20: 8. CrossRef

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: Ying-Ying Yang, Pin-Hsiang Huang, Ling-Yu Yang, Chia-Chang Huang, Chih-Wei Liu, Shiau-Shian Huang, Chen-Huan Chen, Fa-Yauh Lee, Shou-Yen Kao, Boaz Shulruf; J Educ Eval Health Prof. 2022;19:27. Published online October 17, 2022; DOI: https://doi.org/10.3352/jeehp.2022.19.27

3,684 View
141 Download

Abstract PDF Supplementary Material: 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.

Is it possible to introduce an interview to the Korean Medical Licensing Examination to assess professional attributes?: a survey-based observational study: Seung-Joo Na, HyeRin Roh, Kyung Hee Chun, Kyung Hye Park, Do-Hwan Kim; J Educ Eval Health Prof. 2022;19:10. Published online May 10, 2022; DOI: https://doi.org/10.3352/jeehp.2022.19.10

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303 Download

Abstract PDF Supplementary Material: Purpose
This study aimsed to gather opinions from medical educators on the possibility of introducing an interview to the Korean Medical Licensing Examination (KMLE) to assess professional attributes. Specifically following topics were dealt with: the appropriate timing and tool to assess unprofessional conduct; ; the possiblity of prevention of unprofessional conduct by introducing an interview to the KMLE; and the possibility of implementation of an interview to the KMLE.
Methods
A cross-sectional study approach based on a survey questionnaire was adopted. We analyzed 104 pieces of news about doctors’ unprofessional conduct to determine the deficient professional attributes. We derived 24 items of unprofessional conduct and developed the questionnaire and surveyed 250 members of the Korean Society of Medical Education 2 times. Descriptive statistics, cross-tabulation analysis, and Fisher’s exact test were applied to the responses. The answers to the open-ended questions were analyzed using conventional content analysis.
Results
In the survey, 49 members (19.6%) responded. Out of 49, 24 (49.5%) responded in the 2nd survey. To assess unprofessional conduct, there was no dominant timing among basic medical education (BME), KMLE, and continuing professional development (CPD). There was no overwhelming assessment tool among written examination, objective structured clinical examination, practice observation, and interview. Response rates of “impossible” (49.0%) and “possible” (42.9%) suggested an interview of the KMLE prevented unprofessional conduct. In terms of implementation, “impossible” (50.0%) was selected more often than “possible” (33.3%).
Conclusion
Professional attributes should be assessed by various tools over the period from BME to CPD. Hence, it may be impossible to introduce an interview to assess professional attributes to the KMLE, and a system is needed such as self-regulation by the professional body rather than licensing examination.

Review

Educational applications of metaverse: possibilities and limitations: Bokyung Kye, Nara Han, Eunji Kim, Yeonjeong Park, Soyoung Jo; J Educ Eval Health Prof. 2021;18:32. Published online December 13, 2021; DOI: https://doi.org/10.3352/jeehp.2021.18.32

65,176 View
3,649 Download
472 Web of Science
465 Crossref

Abstract PDF Supplementary Material

This review aims to define the 4 types of the metaverse and to explain the potential and limitations of its educational applications. The metaverse roadmap categorizes the metaverse into 4 types: augmented reality, lifelogging, mirror world, and virtual reality. An example of the application of augmented reality in medical education would be an augmented reality T-shirt that allows students to examine the inside of the human body as an anatomy lab. Furthermore, a research team in a hospital in Seoul developed a spinal surgery platform that applied augmented reality technology. The potential of the metaverse as a new educational environment is suggested to be as follows: a space for new social communication; a higher degree of freedom to create and share; and the provision of new experiences and high immersion through virtualization. Some of its limitations may be weaker social connections and the possibility of privacy impingement; the commission of various crimes due to the virtual space and anonymity of the metaverse; and maladaptation to the real world for students whose identity has not been established. The metaverse is predicted to change our daily life and economy beyond the realm of games and entertainment. The metaverse has infinite potential as a new social communication space. The following future tasks are suggested for the educational use of the metaverse: first, teachers should carefully analyze how students understand the metaverse; second, teachers should design classes for students to solve problems or perform projects cooperatively and creatively; third, educational metaverse platforms should be developed that prevent misuse of student data.

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Brief report

Newly appointed medical faculty members’ self-evaluation of their educational roles at the Catholic University of Korea College of Medicine in 2020 and 2021: a cross-sectional survey-based study: Sun Kim, A Ra Cho, Chul Woon Chung; J Educ Eval Health Prof. 2021;18:28. Published online November 5, 2021; DOI: https://doi.org/10.3352/jeehp.2021.18.28

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Abstract PDF Supplementary Material

This study aimed to investigate the degree to which newly appointed medical faculty members at the Catholic University of Korea are aware of Harden and Crosby’s 12 educational roles and to identify their preferred educational roles. A 12-item survey questionnaire was distributed to 110 participants, and 100 responses were included in the analysis. The respondents gave the highest score to “clinical or practical teacher” and the lowest score to “curriculum planner” for their current personal competencies. For their preferred personal future competencies, they assigned the highest score to “on the job role model” and the lowest score to “student assessor.” They gave almost equally high values to all 12 roles. However, individual faculty members had different preferences for educational roles. Accordingly, medical schools need to plan and implement customized faculty development programs, and efforts to provide appropriate educational roles according to individual faculty members’ preferences are needed.

Citations

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Research articles

Definition of character for medical education based on expert opinions in Korea: Yera Hur; J Educ Eval Health Prof. 2021;18:26. Published online September 29, 2021; DOI: https://doi.org/10.3352/jeehp.2021.18.26

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Purpose
This follow-up study focused on 3 overarching questions: what keywords can be extracted from experts’ definitions of character?; what is the operational definition of character for medical students?; and what possible solutions can be suggested to address the issues of character education that were identified in the previous study?
Methods
Sixty-three medical education experts recruited through expert sampling and 19 non-medical education experts recruited through snowball sampling answered a questionnaire that addressed the 3 major questions of the study. The responses were analyzed for descriptive statistics with supplementary keyword extraction tools, including the Cortical and Monkey keyword extractors.
Results
A total of 93 definitional statements were counted, and 138 keyword terms were extracted. The top 5 keyword terms mentioned by the medical education experts were “patient”, “empathy”, “qualities”, “attitude”, and “ability”. These keyword terms were quite different from those mentioned by the non-medical education experts. Based on the extracted keywords, an operational definition of character education by the medical education expert group was presented as follows: the basic qualities and ability to empathize with patients affected by illness based on respect for patients and others. Various methods were proposed to solve the issue of character education, and many of them pointed to curriculum development, such as improvements in teaching and learning methods and evaluation methods, including role modeling.
Conclusion
A clear statement of the concept of character education is the start to resolve issues of character education. Character education improvements will be possible at the institutional level according to the above results.

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Development of a character qualities test for medical students in Korea using polytomous item response theory and factor analysis: a preliminary scale development study
Yera Hur, Dong Gi Seo
Journal of Educational Evaluation for Health Professions.2023; 20: 20. CrossRef
Medical students’ self-evaluation of character, and method of character education
Yera Hur, Sanghee Yeo, Keumho Lee
BMC Medical Education.2022;[Epub] CrossRef
The role of mentoring, supervision, coaching, teaching and instruction on professional identity formation: a systematic scoping review
Rachelle Qi En Toh, Kai Kee Koh, Jun Kiat Lua, Ruth Si Man Wong, Elaine Li Ying Quah, Aiswarya Panda, Chong Yao Ho, Nicole-Ann Lim, Yun Ting Ong, Keith Zi Yuan Chua, Victoria Wen Wei Ng, Sabine Lauren Chyi Hui Wong, Luke Yu Xuan Yeo, Sin Yee See, Jolene J
BMC Medical Education.2022;[Epub] CrossRef

Changes in academic performance in the online, integrated system-based curriculum implemented due to the COVID-19 pandemic in a medical school in Korea: Do-Hwan Kim, Hyo Jeong Lee, Yanyan Lin, Ye Ji Kang; J Educ Eval Health Prof. 2021;18:24. Published online September 23, 2021; DOI: https://doi.org/10.3352/jeehp.2021.18.24

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Purpose
This study examined how students’ academic performance changed after undergoing a transition to online learning during the coronavirus disease 2019 (COVID-19) pandemic, based on the test results of 16 integrated courses conducted in 3 semesters at Hanyang University College of Medicine in Korea.
Methods
For the 16 required courses that formed an integrated system-based curriculum running for 3 semesters, the major examinations’ raw scores were collected for each student. Percent-correct scores were used in the subsequent analysis. We used the t-test to compare grades between 2019 and 2020, and the Cohen D was calculated as a measure of effect size. The correlation of scores between courses was calculated using Pearson correlation coefficients.
Results
There was a significant decrease in scores in 2020 for 10 courses (62.5%). While most of the integrated system-based curriculum test scores showed strong correlations, with coefficients of 0.6 or higher in both 2019 and 2020, the correlation coefficients were generally higher in 2020. When students were divided into low, middle, and high achievement groups, low-achieving students consistently showed declining test scores in all 3 semesters.
Conclusion
Our findings suggest that the transition to online classes due to COVID-19 has led to an overall decline in academic performance. This overall decline, which may occur when the curriculum is centered on recorded lectures, needs to be addressed. Further, medical schools need to consider establishing a support system for the academic development of low-achieving students.

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No difference in learning outcomes and usability between using controllers and hand tracking during a virtual reality endotracheal intubation training for medical students in Thailand: Chaowanan Khundam, Naparat Sukkriang, Frédéric Noël; J Educ Eval Health Prof. 2021;18:22. Published online August 18, 2021; DOI: https://doi.org/10.3352/jeehp.2021.18.22

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Abstract PDF Supplementary Material

Purpose
We developed a virtual reality (VR) endotracheal intubation training that applied 2 interaction modalities (hand-tracking or controllersIt aimed to investigatedthe differences of usuability between using hand tracking and controllers during the VR intervention for intubation training for medical students from February 2021 to March 2021 in Thailand.
Methods
Forty-five participants were divided into 3 groups: video only, video with VR controller training, and video with VR hand tracking training. Pre-test, post-test, and practice scores were used to assess learning outcomes. The System Usability Scale (SUS) and User Satisfaction Evaluation Questionnaire (USEQ) questionnaires were used to evaluate the differences between the VR groups. The sample comprised 45 medical students (undergraduate) who were taking part in clinical training at Walailak University in Thailand.
Results
The overall learning outcomes of both VR groups were better than those of the video group. The post-test scores (P=0.581) and practice scores (P=0.168) of both VR groups were not significantly different. Similarly, no significant between-group differences were found in the SUS scores (P=0.588) or in any aspects of the USEQ scores.
Conclusion
VR enhanced medical training. Interactions using hand tracking or controllers were not significantly different in terms of the outcomes measured in this study. The results and interviews provided a better understanding of support learning and training, which will be further improved and developed to create a self-learning VR medical training system in the future.

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Brief report

Feasibility of clinical performance assessment of medical students on a virtual sub-internship in the United States: John Woller, Sean Tackett, Ariella Apfel, Janet Record, Danelle Cayea, Shannon Walker, Amit Pahwa; J Educ Eval Health Prof. 2021;18:12. Published online June 22, 2021; DOI: https://doi.org/10.3352/jeehp.2021.18.12

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We aimed to determine whether it was feasible to assess medical students as they completed a virtual sub-internship. Six students (out of 31 who completed an in-person sub-internship) participated in a 2-week virtual sub-internship, caring for patients remotely. Residents and attendings assessed those 6 students in 15 domains using the same assessment measures from the in-person sub-internship. Raters marked “unable to assess” in 75/390 responses (19%) for the virtual sub-internship versus 88/3,405 (2.6%) for the in-person sub-internship (P=0.01), most frequently for the virtual sub-internship in the domains of the physical examination (21, 81%), rapport with patients (18, 69%), and compassion (11, 42%). Students received complete assessments in most areas. Scores were higher for the in-person than the virtual sub-internship (4.67 vs. 4.45, P<0.01) for students who completed both. Students uniformly rated the virtual clerkship positively. Students can be assessed in many domains in the context of a virtual sub-internship.

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Association of Virtual Away Rotations With Residency Applicant Outcomes in Otolaryngology
Nicholas R. Lenze, William J. Benjamin, Lauren A. Bohm, Marc C. Thorne, Michael J. Brenner, Angela P. Mihalic, Robbi A. Kupfer
OTO Open.2023;[Epub] CrossRef

Research article

Development and validation of a portfolio assessment system for medical schools in Korea: Dong Mi Yoo, A Ra Cho, Sun Kim; J Educ Eval Health Prof. 2020;17:39. Published online December 9, 2020; DOI: https://doi.org/10.3352/jeehp.2020.17.39

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Purpose
Consistent evaluation procedures based on objective and rational standards are essential for the sustainability of portfolio-based education, which has been widely introduced in medical education. We aimed to develop and implement a portfolio assessment system, and to assess its validity and reliability.
Methods
We developed a portfolio assessment system from March 2019 to August 2019 and confirmed its content validity through expert assessment by an expert group comprising 2 medical education specialists, 2 professors involved in education at medical school, and a professor of basic medical science. Six trained assessors conducted 2 rounds of evaluation of 7 randomly selected portfolios for the “Self-Development and Portfolio II” course from January 2020 to July 2020. These data are used inter-rater reliability was evaluated using intra-class correlation coefficients (ICCs) in September 2020.
Results
The portfolio assessment system is based on the following process; assessor selection, training, analytical/comprehensive evaluation, and consensus. Appropriately trained assessors evaluated portfolios based on specific assessment criteria and a rubric for assigning points. In the analysis of inter-rater reliability, the first round of evaluation grades was submitted, and all assessment areas except “goal-setting” showed a high ICC of 0.81 or higher. After the first round of assessment, we attempted to standardize objective assessment procedures. As a result, all components of the assessments showed close correlations, with ICCs of 0.81 or higher.
Conclusion
We confirmed that when assessors with an appropriate training conduct portfolio assessment based on specified standards through a systematic procedure, the results are reliable.

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Reviews

A proposal for the future of medical education accreditation in Korea: Ki-Young Lim; J Educ Eval Health Prof. 2020;17:32. Published online October 21, 2020; DOI: https://doi.org/10.3352/jeehp.2020.17.32

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For the past 20 years, the medical education accreditation program of the Korean Institute of Medical Education and Evaluation (KIMEE) has contributed significantly to the standardization and improvement of the quality of basic medical education in Korea. It should now contribute to establishing and promoting the future of medical education. The Accreditation Standards of KIMEE 2019 (ASK2019) have been adopted since 2019, with the goal of achieving world-class medical education by applying a learner-centered curriculum using a continuum framework for the 3 phases of formal medical education: basic medical education, postgraduate medical education, and continuing professional development. ASK2019 will also be able to promote medical education that meets community needs and employs systematic assessments throughout the education process. These are important changes that can be used to gauge the future of the medical education accreditation system. Furthermore, globalization, inter-professional education, health systems science, and regular self-assessment systems are emerging as essential topics for the future of medical education. It is time for the medical education accreditation system in Korea to observe and adopt new trends in global medical education.

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Is accreditation in medical education in Korea an opportunity or a burden?: Hanna Jung, Woo Taek Jeon, Shinki An; J Educ Eval Health Prof. 2020;17:31. Published online October 21, 2020; DOI: https://doi.org/10.3352/jeehp.2020.17.31

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Abstract PDF Supplementary Material

The accreditation process is both an opportunity and a burden for medical schools in Korea. The line that separates the two is based on how medical schools recognize and utilize the accreditation process. In other words, accreditation is a burden for medical schools if they view the accreditation process as merely a formal procedure or a means to maintain accreditation status for medical education. However, if medical schools acknowledge the positive value of the accreditation process, accreditation can be both an opportunity and a tool for developing medical education. The accreditation process has educational value by catalyzing improvements in the quality, equity, and efficiency of medical education and by increasing the available options. For the accreditation process to contribute to medical education development, accrediting agencies and medical schools must first be recognized as partners of an educational alliance working together towards common goals. Secondly, clear guidelines on accreditation standards should be periodically reviewed and shared. Finally, a formative self-evaluation process must be introduced for institutions to utilize the accreditation process as an opportunity to develop medical education. This evaluation system could be developed through collaboration among medical schools, academic societies for medical education, and the accrediting authority.

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Current trend of accreditation within medical education: Ducksun Ahn; J Educ Eval Health Prof. 2020;17:30. Published online October 21, 2020; DOI: https://doi.org/10.3352/jeehp.2020.17.30

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Abstract PDF Supplementary Material

Currently, accreditation in medical education is a priority for many countries worldwide. The World Federation for Medical Education’s (WFME) launch of its 1st trilogy of standards in 2003 was a seminal event promoting accreditation in basic medical education (BME) globally. In parallel, the WFME also actively spearheaded a project to recognize accrediting agencies within individual countries. The introduction of competency-based medical education (CBME), with the 2 key concepts of entrusted professional activity and milestones, has enabled researchers to identify the relationships between patient outcomes and medical education. The recent data-driven approach to CBME has been used for ongoing quality improvement of trainees and training programs. The accreditation goal has shifted from the single purpose of quality assurance to balancing quality assurance and quality improvement. Although there are many types of postgraduate medical education (PGME), it may be possible to accredit resident programs on a global scale by adopting the concept of CBME. It will also be possible to achieve accreditation alignment for BME and PGME, which center on competency. This approach may also make it possible to measure accreditation outcomes against patient outcomes. Therefore, evidence of the advantages of costly and labor-consuming accreditation processes will be available soon, and quality improvement will be the driving force of the accreditation process.

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Special reviews on the history and future of the Korean Institute of Medical Education and Evaluation to memorialize its collaboration with the Korea Health Personnel Licensing Examination Institute to designate JEEHP as a co-official journal
Sun Huh
Journal of Educational Evaluation for Health Professions.2020; 17: 33. CrossRef

History of the medical education accreditation system in Korea: implementation and activities in the early stages: Kwang-ho Meng; J Educ Eval Health Prof. 2020;17:29. Published online October 21, 2020; DOI: https://doi.org/10.3352/jeehp.2020.17.29

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Following the opening of 12 new medical schools in Korea in the 1980s, standardization and accreditation of medical schools came to the forefront in the early 1990s. To address the medical community’s concerns about the quality of medical education, the Korean Council for University Education and Ministry of Education conducted a compulsory medical school evaluation in 1996 to see whether medical schools were meeting academic standards or not. This evaluation was, however, a norm-referenced assessment, rather than a criterion-referenced assessment. As a result, the Accreditation Board for Medical Education in Korea (ABMEK) was founded in 1998 as a voluntary organization by the medical community. With full support of the Korean medical community, ABMEK completed its 1st cycle of evaluations of all 41 medical schools from 2000 to 2004. In 2004, ABMEK changed its name to the Korean Institute of Medical Education and Evaluation (KIMEE) as a corporate body. After that, the Korean government paid closer attention to its voluntary accreditation activities. In 2014, the Ministry of Education officially recognized the KIMEE as the 1st professional institute for higher education evaluation accreditation. The most important lesson learned from ABMEK/KIMEE is the importance of collaboration among all medical education-related organizations, including the Korean Medical Association.

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Research articles

Self-care perspective taking and empathy in a student-faculty book club in the United States: Rebecca Henderson, Melanie Gross Hagen, Zareen Zaidi, Valentina Dunder, Edlira Maska, Ying Nagoshi; J Educ Eval Health Prof. 2020;17:22. Published online July 31, 2020; DOI: https://doi.org/10.3352/jeehp.2020.17.22

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Purpose
We aimed to study the impact of a combined faculty-student book club on education and medical practice as a part of the informal curriculum at the University of Florida College of Medicine in the United States.
Methods
Sixteen medical students and 7 faculties who participated in the book club were interviewed through phone and recorded. The interview was then transcribed and entered into the qualitative data analysis program QSR NVivo (QSR International, Burlington, MA, USA). The transcripts were reviewed, and thematic codes were developed inductively through collaborative iteration. Based on these preliminary codes, a coding dictionary was developed and applied to all interviews within QSR Nvivo to identify themes.
Results
Four main themes were identified from interviews: The first theme, the importance of literature to the development and maintenance of empathy and perspective-taking, and the second theme, the importance of the book club in promoting mentorship, personal relationships and professional development, were important to both student and faculty participants. The third and fourth themes, the need for the book club as a tool for self-care and the book club serving as a reminder about the world outside of school were discussed by student book club members.
Conclusion
Our study demonstrated that an informal book club has a significant positive impact on self-care, perspective-taking, empathy, and developing a “world outside of school” for medical school students and faculty in the United States. It also helps to foster meaningful relationships between students and faculty.

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An open book: A virtual book club designed to connect advanced practice registered nurses through quality improvement
Cassandra Faye Newell, Catherine Woods
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GPT Models Can Perform Thematic Analysis in Public Health Studies, Akin to Qualitative Researchers
Yuyi Yang, Charles Alba, Chenyu Wang, Xi Wang, Jami Anderson, Ruopeng An
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The implementation of a required book club for medical students and faculty
David B. Ney, Nethra Ankam, Anita Wilson, John Spandorfer
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Cultivating critical consciousness through a Global Health Book Club
Sarah L. Collins, Stuart J. Case, Alexandra K. Rodriguez, Acquel C. Allen, Elizabeth A. Wood
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Advancing book clubs as non-formal learning to facilitate critical public pedagogy in organizations
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Voluntary assignments during the pediatric clerkship to enhance the clinical experiences of medical students in the United States: Conrad Krawiec, Abigail Kate Myers; J Educ Eval Health Prof. 2020;17:17. Published online May 27, 2020; DOI: https://doi.org/10.3352/jeehp.2020.17.17

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Purpose
Pediatric clerkships that utilize off-campus clinical sites ensure clinical comparability by requiring completion of patient-focused tasks. Some tasks may not be attainable (especially off-campus); thus, they are not assigned. The objective of this study was to evaluate the feasibility of providing a voluntary assignment list to third-year medical students in their pediatric clerkship.
Methods
This is a retrospective single-center cross-sectional analysis of voluntary assignment completion during the 2019–2020 academic year. Third-year medical students were provided a voluntary assignment list (observe a procedure, use an interpreter phone to obtain a pediatric history, ask a preceptor to critique a clinical note, and follow-up on a patient after the rotation ends). Descriptive statistics were used to assess the timing and distribution of voluntary assignment completion.
Results
In total, 132 subjects (77 on the main campus, 55 off-campus) were included. Eighteen (13.6%) main-campus and 16 (12.1%) off-campus students completed at least 1 voluntary assignment. The following voluntary assignments were completed: observe a procedure (15, 11.4%), use an interpreter phone (26, 19.7%), ask a preceptor to critique a clinical note (12, 9.1%), and follow-up on a patient after the rotation ends (7, 5.3%). Off-campus students completed the assignments more often (29.1%) than on-campus students (23.4%)
Conclusion
Our clerkship values specific patient-focused tasks that may enhance student development, but are not attainable at all clinical sites. When provided a voluntary assignment list, 34 out of 132 students (25.8%) completed them. Clerkships that utilize off-campus sites should consider this approach to optimize the pediatric educational experience.

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Adherence to Self - Care Practice Among Type 2 Diabetes Mellitus Patients Using the Theory of Planned Behavior and Health Belief Model at Comprehensive Specialized Hospitals of Amhara Region, Ethiopia: Mixed Method
Wudneh Simegn, Solomon Ahmed Mohammed, Getachew Moges
Patient Preference and Adherence.2023; Volume 17: 3367. CrossRef

Use of graded responsibility and common entrustment considerations among United States emergency medicine residency programs: Jason Lai, Benjamin Holden Schnapp, David Simon Tillman, Mary Westergaard, Jamie Hess, Aaron Kraut; J Educ Eval Health Prof. 2020;17:11. Published online April 20, 2020; DOI: https://doi.org/10.3352/jeehp.2020.17.11

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Purpose
The Accreditation Council for Graduate Medical Education (ACGME) requires all residency programs to provide increasing autonomy as residents progress through training, known as graded responsibility. However, there is little guidance on how to implement graded responsibility in practice and a paucity of literature on how it is currently implemented in emergency medicine (EM). We sought to determine how EM residency programs apply graded responsibility across a variety of activities and to identify which considerations are important in affording additional responsibilities to trainees.
Methods
We conducted a cross-sectional study of EM residency programs using a 23-question survey that was distributed by email to 162 ACGME-accredited EM program directors. Seven different domains of practice were queried.
Results
We received 91 responses (56.2% response rate) to the survey. Among all domains of practice except for managing critically ill medical patients, the use of graded responsibility exceeded 50% of surveyed programs. When graded responsibility was applied, post-graduate year (PGY) level was ranked an “extremely important” or “very important” consideration between 80.9% and 100.0% of the time.
Conclusion
The majority of EM residency programs are implementing graded responsibility within most domains of practice. When decisions are made surrounding graded responsibility, programs still rely heavily on the time-based model of PGY level to determine advancement.

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Needs, rationale, and outcomes of leadership education in neurosurgery
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Journal clubs in Australian medical schools: prevalence, application, and educators’ opinions: Damian James Ianno, Kelly Mirowska-Allen, Stephen Anthony Kunz, Richard O’Brien; J Educ Eval Health Prof. 2020;17:9. Published online February 26, 2020; DOI: https://doi.org/10.3352/jeehp.2020.17.9

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Abstract PDF Supplementary Material

Purpose
Medically-focused journal clubs have been used as an educational tool for over 100 years, with research indicating that they improve knowledge, reading behaviour, and critical appraisal skills. However, it is unknown how widespread they are in Australian medical schools, nor the opinions of medical education leaders as to their value.
Methods
A nationwide cross-sectional study was performed among academic leaders from every Australian medical school. Individuals were asked to complete a survey detailing their attitudes towards journal clubs using single- or multiple-answer questions, Likert scales, and ranked data. They were asked whether students at their institutions were able to partake in journal clubs, and if so, provided details on their implementation.
Results
At least 1 response was collected from 18 of 19 Australian medical schools. The response rate was 40.8% (60 of 147), and 36 responses (60.0%) were from heads of clinical schools. Respondents from 15 of 18 institutions (83.3%) stated that their institution had a journal club. Of these, 23 (65.7%) were metropolitan institutions and 12 (34.3%) were rural institutions. Eighteen (51.4%) journal clubs were clinician-led, 13 (37.1%) were run through specific hospital departments, and 23 (65.7%) occurred during clinical years. Most respondents (20 [57.1%]) stated that the primary aim of the journal club was to develop critical appraisal skills.
Conclusion
Journal clubs are a highly regarded educational tool in the armoury of medical school educators, with significant heterogeneity in their structure, geographic prevalence, and intended purpose. Further studies of their efficacy in teaching evidence-based medicine is warranted.

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Journal club as a teaching–learning strategy: a case for plant genetics lectures during the COVID-19 pandemic
Flavio Lozano-Isla, Elizabeth Heros-Aguilar, Andres Casas-Diaz
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Using a journal club to navigate a maze of COVID-19 papers in a front-line hospital service
Rachel Wenke, Paulina Stehlik, John Gerrard, Sharon Mickan, David Henry
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Club bibliográfico de la Sociedad Española de Radiología Médica: Historia, análisis y perspectivas tras 10 años de trayectoria
D. Herrán de la Gala, C. Biosca Calabuig, J. Miranda Bautista
Radiología.2023; 65(4): 376. CrossRef
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Roaa Aljumaa, Reem Elmokattaf, Mohammad Aljumaa, Haifa Almuhanna , Marukh Rashid , Ismail A Abdullah, Abdul Rahman Sukar
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Software report

Integration of computer-simulated practical exercises into undergraduate medical pharmacology education at Mulungushi University, Zambia: Christian Chinyere Ezeala; J Educ Eval Health Prof. 2020;17:8. Published online February 24, 2020; DOI: https://doi.org/10.3352/jeehp.2020.17.8

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Abstract PDF

Purpose
This study was conducted to determine whether a computer simulation of practical exercises in undergraduate medical pharmacology led to the realization of the intended learning outcomes.
Methods
The study was a descriptive analysis of laboratory classes carried out using computer simulation programs. Five programs were used to teach practical pharmacology to undergraduate medical students at the Mulungushi University School of Medicine and Health Sciences. The study period was January 2018 to December 2019. The computer programs included a pharmacokinetics simulator (CyberPatient), organ bath simulator (OBSim), AutonomiCAL for simulating autonomic pharmacology, and Virtual Cat and Virtual Rat (RatCVS) for simulating cardiovascular pharmacology. Students utilized these programs during their pharmacology laboratory classes, wrote reports, and answered relevant clinical questions.
Results
The 5 programs provided easy and precise platforms for students to explore concepts and demonstrate knowledge of pharmacokinetics, pharmacodynamics, autonomic and cardiovascular pharmacology, and their clinical applications.
Conclusion
The programs were effective learning tools. Students’ learning was easily assessed based on their laboratory reports. Although the computer programs met medical students’ learning needs, wet laboratory exercises are also needed to meet the needs of students who require practical laboratory skills.

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Research articles

Evaluation of a portfolio-based course on self-development for pre-medical students in Korea: Dong Mi Yoo, A Ra Cho, Sun Kim; J Educ Eval Health Prof. 2019;16:38. Published online December 11, 2019; DOI: https://doi.org/10.3352/jeehp.2019.16.38

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Abstract PDF Supplementary Material

Purpose
We have developed and operated a portfolio-based course aimed at strengthening pre-medical students’ capabilities for self-management and self-improvement. In order to determine the effectiveness of the course and to establish future operational strategies, we evaluated the course and the students’ learning experience.
Methods
The subjects of this study were 97 students of a pre-medical course “Self-development and portfolio I” in 2019. Their learning experience was evaluated through the professor’s assessment of portfolios they had submitted, and the program was evaluated based on the responses of 68 students who completed a survey. The survey questionnaire included 32 items. Descriptive statistics were reported for quantitative data, including the mean and standard deviation. Opinions collected from the open-ended question were grouped into categories.
Results
The evaluation of students’ portfolios showed that only 6.2% of the students’ portfolios were well-organized, with specific goals, strategies, processes, and self-reflections, while most lacked the basic components of a portfolio (46.4%) or contained insufficient content (47.4%). Students’ responses to the survey showed that regular portfolio personality assessments (72.1%), team (64.7%), and individual (60.3%) activities were felt to be more appropriate as educational methods for this course, rather than lectures. Turning to the portfolio creation experience, the forms and components of the portfolios (68.2%) and the materials provided (62.2%) were felt to be appropriate. However, students felt that individual autonomy needed to be reflected more (66.7%) and that this course interfered with other studies (42.5%).
Conclusion
The findings of this study suggest that standardized samples, guidelines, and sufficient time for autonomous portfolio creation should be provided. In addition, education on portfolio utilization should be conducted in small groups in the future.

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Early perceptions of portfolios in an outcome-based curriculum
Ahmad AA Omer, J. Vadivelu, Hong WH
BMC Medical Education.2025;[Epub] CrossRef
Assessing the Impact of the Portfolio Workshop and the Use of the Rubric Matrix for Reflective Writing on Medical Faculty and Students
Puja Singh, Sudhir Saxena, Smriti T Pandey, Puja Dulloo
Cureus.2024;[Epub] CrossRef
Medical Student Portfolios: A Systematic Scoping Review
Rei Tan, Jacquelin Jia Qi Ting, Daniel Zhihao Hong, Annabelle Jia Sing Lim, Yun Ting Ong, Anushka Pisupati, Eleanor Jia Xin Chong, Min Chiam, Alexia Sze Inn Lee, Laura Hui Shuen Tan, Annelissa Mien Chew Chin, Limin Wijaya, Warren Fong, Lalit Kumar Radha K
Journal of Medical Education and Curricular Development.2022;[Epub] CrossRef
Development and validation of a portfolio assessment system for medical schools in Korea
Dong Mi Yoo, A Ra Cho, Sun Kim
Journal of Educational Evaluation for Health Professions.2020; 17: 39. CrossRef

Effect of student-directed solicitation of evaluation forms on the timeliness of completion by preceptors in the United States: Conrad Krawiec, Vonn Walter, Abigail Kate Myers; J Educ Eval Health Prof. 2019;16:32. Published online October 16, 2019; DOI: https://doi.org/10.3352/jeehp.2019.16.32

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Abstract PDF Supplementary Material

Purpose
Summative evaluation forms assessing a student’s clinical performance are often completed by a faculty preceptor at the end of a clinical training experience. At our institution, despite the use of an electronic system, timeliness of completion has been suboptimal, potentially limiting our ability to monitor students’ progress. The aim of the present study was to determine whether a student-directed approach to summative evaluation form collection at the end of a pediatrics clerkship would enhance timeliness of completion for third-year medical students.
Methods
This was a pre- and post-intervention educational quality improvement project focused on 156 (82 pre-intervention, 74 post-intervention) third-year medical students at Penn State College of Medicine completing their 4-week pediatric clerkship. Utilizing REDCap (Research Electronic Data Capture) informatics support, student-directed evaluation form solicitation was encouraged. The Wilcoxon rank-sum test was applied to compare the pre-intervention (May 1, 2017 to March 2, 2018) and post-intervention (April 2, 2018 to December 21, 2018) percentages of forms completed before the rotation midpoint.
Results
In total, 740 evaluation forms were submitted during the pre-intervention phase and 517 during the post-intervention phase. The percentage of forms completed before the rotation midpoint increased after implementing student-directed solicitation (9.6% vs. 39.7%, P<0.05).
Conclusion
Our clerkship relies on subjective summative evaluations to track students’ progress, deploy improvement strategies, and determine criteria for advancement; however, our preceptors struggled with timely submission. Allowing students to direct the solicitation of evaluation forms enhanced the timeliness of completion and should be considered in clerkships facing similar challenges.

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Improving Time to Completion of Medical Student Clerkship Evaluations
Michelle D. Veters, Brian May, Chang L. Wu, Erinn O. Schmit, Stephanie Berger
Hospital Pediatrics.2025; 15(1): 74. CrossRef

Goodness of fit of the items used in the 2nd cycle of evaluation and accreditation of medical schools by the Korea Institute of Medical Education and Evaluation based on the Rasch model: Man Sup Lim, Sun Huh; J Educ Eval Health Prof. 2019;16:28. Published online September 30, 2019; DOI: https://doi.org/10.3352/jeehp.2019.16.28

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Abstract PDF Supplementary Material

Purpose
Since 2004, the Korea Institute of Medical Education and Evaluation has been responsible for the evaluation and accreditation of medical schools in Korea. The 2nd cycle of evaluations was conducted from 2007 to 2011. The present study aimed at testing the goodness of fit of the items used in the 2nd cycle of evaluation and accreditation based on the Rasch model.
Methods
Dichotomous data on 40 medical schools were analyzed using Winsteps, a tool based on the Rasch model that includes goodness-of-fit testing.
Results
Two of the 109 items had an outfit mean square exceeding 2.0. The other 107 items showed a goodness of fit in the acceptable range for the outfit mean square. All items were in the acceptable range in terms of the infit mean square. Furthermore, 1 school had an outfit mean square exceeding 2.0, while all schools were in the acceptable range for the infit mean square. An outfit mean square value over 2.0 means that an item is a outlier. Therefore, 2 items showed an extreme response relative to the overall response. Meanwhile, the finding of an outfit mean square over 2.0 for 1 school means that it showed extraordinary responses to specific items, despite its excellent overall competency.
Conclusion
The goodness of fit of the items used for evaluation and accreditation by the Korea Institute of Medical Education and Evaluation should be checked so that they can be revised appropriately. Furthermore, the outlier school should be investigated to determine why it showed such an inappropriate goodness of fit.

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IJORER : International Journal of Recent Educational Research.2024; 5(2): 268. CrossRef
Changes in the accreditation standards of medical schools by the Korean Institute of Medical Education and Evaluation from 2000 to 2019
Hyo Hyun Yoo, Mi Kyung Kim, Yoo Sang Yoon, Keun Mi Lee, Jong Hun Lee, Seung-Jae Hong, Jung –Sik Huh, Won Kyun Park
Journal of Educational Evaluation for Health Professions.2020; 17: 2. CrossRef
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Ophthalmology training and competency levels in caring for patients with ophthalmic complaints among United States internal medicine, emergency medicine, and family medicine residents: Christopher Daniel Gelston, Jennifer Landrigan Patnaik; J Educ Eval Health Prof. 2019;16:25. Published online August 29, 2019; DOI: https://doi.org/10.3352/jeehp.2019.16.25

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Abstract PDF Supplementary Material

Purpose
To evaluate ophthalmic educational training and confidence in caring for patients with ophthalmic complaints among internal, emergency, and family medicine residents in the United States.
Methods
A 41-item cross-sectional survey was sent to the directors of 529 internal medicine, 237 emergency medicine, and 629 family medicine residency programs, who distributed it to residents in those programs. The survey included the number of ophthalmic education hours residents received. Respondents were asked to rate their confidence in performing an ophthalmic exam and treating patients with ocular conditions using a 5-point Likert scale ranging from “not confident” to “very confident.”
Results
In total, 92.5% of internal medicine, 66.8% of emergency medicine, and 74.5% of family medicine residents received less than 10 hours of ophthalmic education during residency. Most respondents (internal medicine, 59.1%; emergency medicine, 76.0%; family medicine, 65.7%) reported that patients with ocular complaints constituted 1%–5% of visits. Mean±standard deviation confidence levels in performing an eye exam and treating patients with ophthalmic conditions were highest in emergency medicine residency programs (2.9±0.7), followed by family medicine (2.3±0.6) and internal medicine (2.2±0.6). A higher reported number of ophthalmic education hours in residency was associated with greater confidence among emergency (P<0.001), family (P<0.001), and internal (P=0.005) medicine residents.
Conclusion
Internal, emergency, and family medicine residents receive limited ophthalmic education, as reflected by their overall low confidence levels in performing an ophthalmic exam and treating patients with ocular complaints. An increase in ophthalmic educational hours during their residencies is recommended to improve upon this knowledge gap.

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Blake Hopkin, Thellea Leveque, Mary Kim, Anna McEvoy, Karine Bojikian, Jennifer T. Yu, Shu Feng
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Identification and evaluation of the core elements of character education for medical students in Korea: Yera Hur, Keumho Lee; J Educ Eval Health Prof. 2019;16:21. Published online August 20, 2019; DOI: https://doi.org/10.3352/jeehp.2019.16.21

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Abstract PDF Supplementary Material

Purpose
Medicine requires uniquely high levels of motivation, ethics, and altruistic values and behavior. This study was conducted to redefine character education in medical education and to identify and evaluate the core elements of physicians’ character.
Methods
A 3-round Delphi survey was conducted among professors of medical education, physicians, experts from nursing schools, and a head nurse in Korea. A consultant group (CG) was formed to prepare the Delphi survey, discuss the research results, and set directions for future initiatives. The 3 rounds of the Delphi survey were conducted between September 2018 and February 2019.
Results
From the first-round Delphi survey, which inquired about the 10 key character elements required for medical students, a total of 420 elements were collected. The top 10 categories were selected and classified. After the second and third rounds of the Delphi consensus process and a series of CG meetings, the following 8 core categorical elements were identified: service and sacrifice, empathy and communication, care and respect, honesty and humility, responsibility and calling, collaboration and magnanimity, creativity and positivity, and patience and leadership. The average score of medical graduates for the core elements ranged from 2.45 to 3.46 (standard deviation, 0.23–0.60) on a 5-point Likert scale.
Conclusion
Eight core categorical elements of the character of medical students were identified. The results of this study can be used as a reference for establishing the goals and desired outcomes of character education at the level of undergraduate or graduate medical education.

Citations

Citations to this article as recorded by

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