Journal of Educational Evaluation for Health Professions

Research articles

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

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

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

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

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

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

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

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

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.

Factors influencing the learning transfer of nursing students in a non-face-to-face educational environment during the COVID-19 pandemic in Korea: a cross-sectional study using structural equation modeling: Geun Myun Kim, Yunsoo Kim, Seong Kwang Kim; J Educ Eval Health Prof. 2023;20:14. Published online April 27, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.14

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Purpose
The aim of this study was to identify factors influencing the learning transfer of nursing students in a non-face-to-face educational environment through structural equation modeling and suggest ways to improve the transfer of learning.
Methods
In this cross-sectional study, data were collected via online surveys from February 9 to March 1, 2022, from 218 nursing students in Korea. Learning transfer, learning immersion, learning satisfaction, learning efficacy, self-directed learning ability and information technology utilization ability were analyzed using IBM SPSS for Windows ver. 22.0 and AMOS ver. 22.0.
Results
The assessment of structural equation modeling showed adequate model fit, with normed χ2=1.74 (P<0.024), goodness-of-fit index=0.97, adjusted goodness-of-fit index=0.93, comparative fit index=0.98, root mean square residual=0.02, Tucker-Lewis index=0.97, normed fit index=0.96, and root mean square error of approximation=0.06. In a hypothetical model analysis, 9 out of 11 pathways of the hypothetical structural model for learning transfer in nursing students were statistically significant. Learning self-efficacy and learning immersion of nursing students directly affected learning transfer, and subjective information technology utilization ability, self-directed learning ability, and learning satisfaction were variables with indirect effects. The explanatory power of immersion, satisfaction, and self-efficacy for learning transfer was 44.4%.
Conclusion
The assessment of structural equation modeling indicated an acceptable fit. It is necessary to improve the transfer of learning through the development of a self-directed program for learning ability improvement, including the use of information technology in nursing students’ learning environment in non-face-to-face conditions.

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The Mediating Effect of Perceived Institutional Support on Inclusive Leadership and Academic Loyalty in Higher Education
Olabode Gbobaniyi, Shalini Srivastava, Abiodun Kolawole Oyetunji, Chiemela Victor Amaechi, Salmia Binti Beddu, Bajpai Ankita
Sustainability.2023; 15(17): 13195. 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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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.

Comparison of nursing students’ performance of cardiopulmonary resuscitation between 1 semester and 3 semesters of manikin simulations in the Czech Republic: a non-randomized controlled study: Vera Spatenkova, Iveta Zvercova, Zdenek Jindrisek, Ivana Veverkova, Eduard Kuriscak; J Educ Eval Health Prof. 2023;20:9. Published online March 31, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.9

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Abstract PDF Supplementary Material: Purpose
This study aimed to assess the effect of simulation teaching in critical care courses in a nursing study program on the quality of chest compressions of cardiopulmonary resuscitation (CPR).
Methods
An observational cross-sectional study was conducted at the Faculty of Health Studies at the Technical University of Liberec. The success rate of CPR was tested in exams comparing 2 groups of students, totaling 66 different individuals, who completed half a year (group 1: intermediate exam with model simulation) or 1.5 years (group 2: final theoretical critical care exam with model simulation) of undergraduate nursing critical care education taught completely with a Laerdal SimMan 3G simulator. The quality of CPR was evaluated according to 4 components: compression depth, compression rate, time of correct frequency, and time of correct chest release.
Results
Compression depth was significantly higher in group 2 than in group 1 (P=0.016). There were no significant differences in the compression rate (P=0.210), time of correct frequency (P=0.586), or time of correct chest release (P=0.514).
Conclusion
Nursing students who completed the final critical care exam showed an improvement in compression depth during CPR after 2 additional semesters of critical care teaching compared to those who completed the intermediate exam. The above results indicate that regularly scheduled CPR training is necessary during critical care education for nursing students.

Effect of a smartphone-based online electronic logbook to evaluate the clinical skills of nurse anesthesia students in Iran: a randomized controlled study: Ali Khalafi, Nahid Jamshidi, Nasrin Khajeali, Saeed Ghanbari; J Educ Eval Health Prof. 2023;20:10. Published online March 31, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.10

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Abstract PDF Supplementary Material: Purpose
This study was conducted to evaluate a smartphone-based online electronic logbook used to assess the clinical skills of nurse anesthesia students in Iran.
Methods
This randomized controlled study was conducted after tool development at Ahvaz Jundishapur University of Medical Sciences in Ahvaz, Iran from January 2022 to December 2022. The online electronic logbook involved in this study was an Android-compatible application used to evaluate the clinical skills of nurse anesthesia students. In the implementation phase, the online electronic logbook was piloted for 3 months in anesthesia training in comparison with a paper logbook. For this purpose, 49 second- and third-year anesthesia nursing students selected using the census method were assigned to intervention (online electronic logbook) and control (paper logbook) groups. The online electronic logbook and paper logbook were compared in terms of student satisfaction and learning outcomes.
Results
A total of 39 students participated in the study. The mean satisfaction score of the intervention group was significantly higher than that of the control group (P=0.027). The mean score of learning outcomes was also significantly higher for the intervention than the control group (P=0.028).
Conclusion
Smartphone technology can provide a platform for improving the evaluation of the clinical skills of nursing anesthesia students, leading to increased satisfaction and improved learning outcomes.

What impacts students’ satisfaction the most from Medicine Student Experience Questionnaire in Australia: a validity study: Pin-Hsiang Huang, Gary Velan, Greg Smith, Melanie Fentoullis, Sean Edward Kennedy, Karen Jane Gibson, Kerry Uebel, Boaz Shulruf; J Educ Eval Health Prof. 2023;20:2. Published online January 18, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.2

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Purpose
This study evaluated the validity of student feedback derived from Medicine Student Experience Questionnaire (MedSEQ), as well as the predictors of students’ satisfaction in the Medicine program.
Methods
Data from MedSEQ applying to the University of New South Wales Medicine program in 2017, 2019, and 2021 were analyzed. Confirmatory factor analysis (CFA) and Cronbach’s α were used to assess the construct validity and reliability of MedSEQ respectively. Hierarchical multiple linear regressions were used to identify the factors that most impact students’ overall satisfaction with the program.
Results
A total of 1,719 students (34.50%) responded to MedSEQ. CFA showed good fit indices (root mean square error of approximation=0.051; comparative fit index=0.939; chi-square/degrees of freedom=6.429). All factors yielded good (α>0.7) or very good (α>0.8) levels of reliability, except the “online resources” factor, which had acceptable reliability (α=0.687). A multiple linear regression model with only demographic characteristics explained 3.8% of the variance in students’ overall satisfaction, whereas the model adding 8 domains from MedSEQ explained 40%, indicating that 36.2% of the variance was attributable to students’ experience across the 8 domains. Three domains had the strongest impact on overall satisfaction: “being cared for,” “satisfaction with teaching,” and “satisfaction with assessment” (β=0.327, 0.148, 0.148, respectively; all with P<0.001).
Conclusion
MedSEQ has good construct validity and high reliability, reflecting students’ satisfaction with the Medicine program. Key factors impacting students’ satisfaction are the perception of being cared for, quality teaching irrespective of the mode of delivery and fair assessment tasks which enhance learning.

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Mental health and quality of life across 6 years of medical training: A year-by-year analysis
Natalia de Castro Pecci Maddalena, Alessandra Lamas Granero Lucchetti, Ivana Lucia Damasio Moutinho, Oscarina da Silva Ezequiel, Giancarlo Lucchetti
International Journal of Social Psychiatry.2023;[Epub] CrossRef

Brief report

Are ChatGPT’s knowledge and interpretation ability comparable to those of medical students in Korea for taking a parasitology examination?: a descriptive study: Sun Huh; J Educ Eval Health Prof. 2023;20:1. Published online January 11, 2023; DOI: https://doi.org/10.3352/jeehp.2023.20.1

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This study aimed to compare the knowledge and interpretation ability of ChatGPT, a language model of artificial general intelligence, with those of medical students in Korea by administering a parasitology examination to both ChatGPT and medical students. The examination consisted of 79 items and was administered to ChatGPT on January 1, 2023. The examination results were analyzed in terms of ChatGPT’s overall performance score, its correct answer rate by the items’ knowledge level, and the acceptability of its explanations of the items. ChatGPT’s performance was lower than that of the medical students, and ChatGPT’s correct answer rate was not related to the items’ knowledge level. However, there was a relationship between acceptable explanations and correct answers. In conclusion, ChatGPT’s knowledge and interpretation ability for this parasitology examination were not yet comparable to those of medical students in Korea.

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Reviews

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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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).

Citations

Citations to this article as recorded by

Performance of ChatGPT on the Peruvian National Licensing Medical Examination: Cross-Sectional Study
Javier A Flores-Cohaila, Abigaíl García-Vicente, Sonia F Vizcarra-Jiménez, Janith P De la Cruz-Galán, Jesús D Gutiérrez-Arratia, Blanca Geraldine Quiroga Torres, Alvaro Taype-Rondan
JMIR Medical Education.2023; 9: e48039. CrossRef

Medical students’ satisfaction level with e-learning during the COVID-19 pandemic and its related factors: a systematic review: Mahbubeh Tabatabaeichehr, Samane Babaei, Mahdieh Dartomi, Peiman Alesheikh, Amir Tabatabaee, Hamed Mortazavi, Zohreh Khoshgoftar; J Educ Eval Health Prof. 2022;19:37. Published online December 20, 2022; DOI: https://doi.org/10.3352/jeehp.2022.19.37

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Purpose
This review investigated medical students’ satisfaction level with e-learning during the coronavirus disease 2019 (COVID-19) pandemic and its related factors.
Methods
A comprehensive systematic search was performed of international literature databases, including Scopus, PubMed, Web of Science, and Persian databases such as Iranmedex and Scientific Information Database using keywords extracted from Medical Subject Headings such as “Distance learning,” “Distance education,” “Online learning,” “Online education,” and “COVID-19” from the earliest date to July 10, 2022. The quality of the studies included in this review was evaluated using the appraisal tool for cross-sectional studies (AXIS tool).
Results
A total of 15,473 medical science students were enrolled in 24 studies. The level of satisfaction with e-learning during the COVID-19 pandemic among medical science students was 51.8%. Factors such as age, gender, clinical year, experience with e-learning before COVID-19, level of study, adaptation content of course materials, interactivity, understanding of the content, active participation of the instructor in the discussion, multimedia use in teaching sessions, adequate time dedicated to the e-learning, stress perception, and convenience had significant relationships with the satisfaction of medical students with e-learning during the COVID-19 pandemic.
Conclusion
Therefore, due to the inevitability of online education and e-learning, it is suggested that educational managers and policymakers choose the best online education method for medical students by examining various studies in this field to increase their satisfaction with e-learning.

Citations

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Physician Assistant Students’ Perception of Online Didactic Education: A Cross-Sectional Study
Daniel L Anderson, Jeffrey L Alexander
Cureus.2023;[Epub] CrossRef
Mediating Role of PERMA Wellbeing in the Relationship between Insomnia and Psychological Distress among Nursing College Students
Qian Sun, Xiangyu Zhao, Yiming Gao, Di Zhao, Meiling Qi
Behavioral Sciences.2023; 13(9): 764. 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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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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Citations to this article as recorded by

Feedback conversations: First things first?
Katharine A. Robb, Marcy E. Rosenbaum, Lauren Peters, Susan Lenoch, Donna Lancianese, Jane L. Miller
Patient Education and Counseling.2023; 115: 107849. CrossRef

Brief report

Self-directed learning quotient and common learning types of pre-medical students in Korea by the Multi-Dimensional Learning Strategy Test 2nd edition: a descriptive study: Sun Kim, A Ra Cho, Chul Woon Chung; J Educ Eval Health Prof. 2022;19:32. Published online November 28, 2022; DOI: https://doi.org/10.3352/jeehp.2022.19.32

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Abstract PDF Supplementary Material: This study aimed to find the self-directed learning quotient and common learning types of pre-medical students through the confirmation of 4 characteristics of learning strategies, including personality, motivation, emotion, and behavior. The response data were collected from 277 out of 294 target first-year pre-medical students from 2019 to 2021, using the Multi-Dimensional Learning Strategy Test 2nd edition. The most common learning type was a self-directed type (44.0%), stagnant type (33.9%), latent type (14.4%), and conscientiousness type (7.6%). The self-directed learning index was high (29.2%), moderate (24.6%), somewhat high (21.7%), somewhat low (14.4%), and low (10.1%). This study confirmed that many students lacked self-directed learning capabilities for learning strategies. In addition, it was found that the difficulties experienced by each student were different, and the variables resulting in difficulties were also diverse. It may provide insights into how to develop programs that can help students increase their self-directed learning capability.

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