Purpose The COVID-19 (coronavirus disease 2019) pandemic led to significant changes in clinical clerkships, including reduced ward rounds. We aimed to determine how the pandemic–induced changes in the clinical practice environment affect the clinical performance of medical students.
Methods We analyzed objective structured clinical examination scores of third- and fourth-year medical students from 2019–2020 and 2020–2021 across six stations by the Seoul–Gyeonggi Consortium. Clinical, communication, and ability scores were measured and analyzed using repeated-measures multivariate analysis of variance.
Results The interaction between clinical practice progress and pandemic-induced changes significantly affected physical examination and medical history scores, though the differences were not substantial. Patient-physician interaction significance varied by measurement period. Clinical communication ability also showed significant differences based on the measurement period and practical experience.
Conclusion During the pandemic, alternative learning methods, including self–learning, simulation/practice, and peer role–play, helped improve medical competency in areas such as history–taking and physical examination. However, these were less effective in improving patient–physician interactions or clinical communication efficacy. Alternative learning methods have limitations, and they cannot replace direct patient encounters in clinical practice.
Purpose The aim of this study was to inquire about the clinical performance and determine the performance pattern of medical students in standardized patient (SP) based examinations of domestic violence (DV).
Methods The clinical performance sores in DV station with SP of third-year (n=111, in 2014) and 4th-year (n=143, in 2016) medical students of five universities in the Busan-Gyeongnam Clinical Skills Examination Consortium were subjected in this study. The scenarios and checklists of DV cases were developed by the case development committee of the consortium. The students’ performance was compared with other stations encountered in SP. The items of the checklists were categorized to determine the performance pattern of students investigating DV into six domains: disclosure strategy (D), DV related history taking (H), checking the perpetrator’s psychosocial state (P), checking the victim’s condition (V), negotiating and persuading the interviewee (N), and providing information about DV (I).
Results Medical students showed poorer performance in DV stations than in the other stations with SP in the same examination. Most students did confirm the perpetrator and commented on confidentiality but ignored the perpetrator’s state and patient’s physical and psychological condition. The students performed well in the domains of D, H, and I but performed poorly in domains P, V, and N.
Conclusion Medical students showed poor clinical performance in the DV station. They performed an ‘event oriented interview’ rather than ‘patient centered’ communication. An integrated educational program of DV should be set to improve students’ clinical performance.
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Purpose To determine whether disclosure of scoring rubric for objective basic clinical skills can improve the scores on the objective structured clinical examination (OSCE) in medical students.
Methods Clinical performance score results of one university medical students (study group, n=345) were compared to those of another university (control group, n=1,847). Both groups took identical OSCE exam. OSCE rubric was not revealed to the study group until they were in the last 2 years of medical school.
Results There was no significant difference between before and after disclosure of rubric. However, history taking and physical examination scores of the study group were lower than those of the control group before the disclosure of rubric. After disclosure of rubric, the scores were either unchanged or slightly increased in the control group. Trend analysis of scores demonstrated that history taking and physical examination scores after the disclosure were significantly increased in the study group for 2 years.
Conclusion This study revealed that disclosure of basic clinical skills rubric to medical students could enhance their clinical performance, particularly in history taking and physical examination scores.
Purpose The purpose of this study was to compare the differences in self-efficacy in clinical performance (SECP) between medical students and residents. Methods: A total of 267 medical students and 110 residents participated in a survey on SECP with regard to seven factors: knowledge acquisition and application, clinical reasoning, clinical skills, communication with patients, relationships with other health professionals, medical ethics, and self-development. The data were examined by multivariate analysis of variance. Results: Residents had higher scores for clinical skills than students (F[1, 372]=8.919, p<0.01), whereas students scored significantly higher for communication with patients (F[1, 372]=26.779, p<0.001), relationships with other health professionals (F[1, 372]=12.807, p<0.001), medical ethics (F[1, 372]=40.136, p<0.001), and self-development (F[1, 372]=32.380, p<0.001). There were no differences between genders or specialties of residents. Conclusion: There are differences in SECP between students and residents. These results can guide the design of self-efficacy improvement programs.
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Purpose This school-level longitudinal study examined 7 years of clinical performance data to determine differences (effects) in students and annual changes within a school and between schools; examine how much their predictors (characteristics) influenced the variation in student performance; and calculate estimates of the schools’ initial status and growth.
Methods A school-level longitudinal model was tested: level 1 (between students), level 2 (annual change within a school), and level 3 (between schools). The study sample comprised students who belonged to the CPX Consortium (n=5,283 for 2005~2008 and n=4,337 for 2009~2011).
Results Despite a difference between evaluation domains, the performance outcomes were related to individual large-effect differences and small-effect school-level differences. Physical examination, clinical courtesy, and patient education were strongly influenced by the school effect, whereas patient-physician interaction was not affected much.
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Purpose The importance of team dynamics with regard to clinical performance is being emphasized to improve patient safety and the quality of health care. The aim of this study was to examine the correlation and differences in team dynamics and team clinical performance in a web-based simulation (WS) and high-fidelity simulation (HS) in the medical students. Methods: The simulations were held for 15 teams of fourth year medical students (n=52). They were given two clinical cases, dyspnea (case 1) and chest pain (case 2) by WS and then HS. The scores on the team dynamics and the team’s clinical performance were analyzed by paired t-test and multiple regression using SPSS version 21.0 (IBM Corp.). Results: The teamwork scores on case 2 (22.67±6.58) were higher than for case 1 in the HS (20.47±7.22). Team clinical performance scores were the same the WS and HS. Team clinical performances were significantly associated with team dynamics in both cases by HS. Teamwork scores of team dynamics were each explanation on case 1 (74.9%), case 2 (63.4%) in the HS. Conclusion: The team dynamics and clinical performance can improve if undergraduate medical students have more opportunities. They should be trained in these endeavors to become future doctors for which scenario-based simulations could be valuable.
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Purpose From 2009, the Korean Medical Licensure Exam implemented a clinical performance examination (CPX) that highlighted the importance of good patient-physician relationships in medical education. This study aimed to examine changes in medical students’ attitudes before and after implementation of the CPX in their medical education curriculum.
Methods In 2006 and 2009, 236 fourth-year medial students of C College of Medicine took the Patient Practitioner Orientation Scale (PPOS) by Krupet et al. (2000), which measures patient-centered attitudes in patient-physician relationships. The data were analyzed by independent t-test and two-way analysis of variance using SPSS 21.0.
Results The PPOS scores of year 2006 students were 3.88±0.25 for males and 3.98±0.38 for females. For year 2009 students, males scored 3.81±0.42 and females scored 4.01±0.48. All students had higher Care scores than Share scores (2006: Share, 3.67±0.47 vs. Care, 4.19±0.51; 2009: Share, 3.56±0.34 vs. Care, 4.18±0.53). There were significant differences in PPOS and Share scores by gender before and after the CPX. With regard to Care scores, female students' scores tended to rise and males' scores declined over time.
Conclusion An educational program is needed for students to foster patient-centered attitudes, but gender differences should be taken into account.
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PURPOSE To evaluate the clinical performance through the Korean Medical Licensing Examination clinical skills assessment (KMLE CSA) this survey was done.
METHODS A survey of 130 interns and residents (46 applicants and 84 non-applicants for the KMLE CSA) at a university hospital in Seoul was conducted in January and February 2012. The data were gathered using a structured and self-administered questionnaire. For the items that assessed the clinical performance of these subjects, we selected 15 items that are mostly frequently used by Delphi's technique, and difficult procedural skills based on the results of medical students' performance. We also used subcomponents of the clinical problems test of the KMLE CSA.
RESULTS The total score on the KMLE CSA improved by 1.33 points (a perfect score is 10), 1.49 points for procedural skills, and 0.84 points for clinical problems by multiple regression analysis. The variables that influenced clinical skills were sex (females had 0.86 more points than males), experience in military or public services (1.04 points higher than persons without experience), and type of school (graduates of medical school had 1.41 more points than graduates of professional graduate school).
CONCLUSION Implementation of the KMLE CSA improved the clinical performance of medical graduates.
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PURPOSE Most medical schools have held clinical skills training programs recently. Despite these educational endeavors, few studies have attempted to address the effect of clinical skills assessments on clinical performance. This study investigated whether repeated experiences with the examination improved medical students' history-taking, physical exams, and patient-physician interactions (PPIs).
METHODS The subjects of the study were 101 4th-year medical students who participated in the clinical performance examination (CPX) 3 times. They completed their core clerkship before acquiring the first CPX scores; we tracked down the scores of three sets of CPX for 3 subdomains (history taking, physical exam, and patient-physician interaction) and investigated the changes in these scores.
Additionally, we classified the research subjects into 3 groups by total CPX score-higher (upper 30%, n=30), intermediate (medium 40%, n=40), and lower (lower 30%, n=30)-and compared the curves for each group.
RESULTS Significant improvements were made on history taking and physical exam (F=130.786/237.358, p<0.01), while proficiency on the PPI declined (F=17.621, p<0.01).
Additionally, scores in all levels improved continuously on history taking and physical exam, while students of the high and low levels experienced a sharp decline on the PPI (F=11.628, p<0.01).
CONCLUSION Improvement in the history-taking score reflects an accumulation of clinical knowledge and clinical exposure.
Improvement on the physical exam score is affected by repeated practice on similar or identical cases and receipt of feedback. That PPI can deteriorate might be an effect of one's negative experience in a clinical clerkship.
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PURPOSE The patient-physician interaction (PPI) is a critical part of the clinical encounter. Recent studies have emphasized the importance of the emotional intelligence (EI) of physician in the PPI. Despite emphasizing the EI, previous studies offer limited evidence regarding the effect of a student's EI on the PPI. The purpose of this study is to explore the differences in EI depending on the demographics of medical students and the correlation between EI and PPI scores.
METHODS The sample was 85 fourth-grade medical students.
Prior to taking a 12-station clinical performance examination, the students completed questionnaires on their own perception of the EI, which included 5 domains and 50 items. The tool that was used to assess the level of EI was Moon's modified version of the EI test for adults. We investigated differences in EI depending on the demographics of medical students by ANOVA and noted a correlation between EI and PPI scores by stepwise multiple regression analysis.
RESULTS This study found that females or graduate entry students have higher EI scores and that 25 to 30-year-old students have higher EI scores than aged under 25 years. The PPI scores correlated positively with total EI scores (r=0.32) and 2 subdomains (perception and expression of emotion, r=0.26; empathy, r=0.33). Two subdomains were the best predictors of PPI score (R2=0.171).
CONCLUSION EI correlates significantly with PPI score and affects it. We conclude that EI is a key influence of the PPI. Further research is required to explore whether this is a consistent effect.
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PURPOSE The purpose of this study is to test the reliability of the clinical performance examination (CPX) using Generalizability theory (G-theory). Through G-theory, the effects of not only students and tasks but also the school will be analyzed as primary sources of error, which can affect the interpretation of the reliability of the CPX.
METHODS One thousand three hundred nineteen students from 16 medical schools that participated in the Seoul-Gyeonggi CPX Consortium 2008 were enrolled. In our research design, we suppose that student is nested within school and crossed with task. Data analysis was conducted with urGenova.
RESULTS According to our analysis, the percentage of error variance was 6.2% for school, 14.9% for student nested within school, 14.4% for task, and 3% for interaction between school and task. An effect of school on students was observed, but the interaction between task and school was insignificant. When student is nested within school, the universe score decreased and the g-coefficient was less than the g-coefficient of the p x t (p: studentm, t: task) design.
CONCLUSION The results show that generalizability theory is useful in detecting various error components in the CPX.
Using the generalizability theory to improve the technical quality of performance assessments provides us with greater information compared with traditional test theories.
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PURPOSE The purpose of this study was to assess the clinical experiences (in internal medicine) of medical students, and compare the self-assessment of their competency in clinical skills with the assessment of instructors through the OSCE. METHODS: The frequency of clinical experiences had by medical students and the self-assessments of their confidence in clinical skills were assessed by questionnaires administered before the OSCE. 52 medical students participated in the OSCE. After completing the OSCE, they re-evaluated their own performance of 9 clinical skills examined in the OSCE by self-assessment questionnaires. The scores of these self-assessments were compared with the scores given by the instructors. RESULTS: For 19 of 28 clinical skills items listed in the questionnaires, self-assessment of competence by medical students correlated with the frequency of performance (p<0.05). For 9 clinical skills in the OSCE, the self-assessment scores did not correlate significantly with the instructors' assessment scores (p>0.05). However, these 9 clinical skills scores from the instructors correlated significantly with the clerkship evaluation scores and the final semester grade point averages (p<0.05). CONCLUSION: There was a significant association between frequency of performance and self-assessed competency, which did not correlate significantly with the instructors' evaluation through the OSCE.
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PURPOSE The purpose of this study is to analyse the gap between what medical students learn in theory and their clinical performance in reality. The hypothesis is that students with high written examination scores will also perform better in the Clinical Performance Examination (CPX).
METHODS 128 Catholic University medical students in year four took the CPX on 24th, September 2005. 40 standardized patients (SPs) were involved as assessors. Each student performed five CPX cases. The students' written examination scores of year three, SPs' assessment scores were used as instruments. Students were divided into two groups (A and B) and each group consisted of 64 students. Correlation between the written examination scores and the CPX scores, CPX case scores and related written examination scores were analysed.
RESULTS Overall, there was no significant correlation between the CPX score and the written examination scores in total, but significant correlations were shown in family medicine CPX scores of both groups A and B (pearson=.308, p=.199; pearson=.258, p=.051). From the analysis of the CPX cases and related written examination scores, group A showed significant correlation in three out of the five cases. No significant correlation seen in group B.
CONCLUSION It can be concluded that large gaps still exist between theory and practice. Some suggestions are given to minimize these gap.
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PURPOSE The objectives of this study were: 1) to analyze Clinical Performance Examination(CPX) items using item response theory(IRT) and classical test theory(CTT) and 2) to discuss how to apply and interpret these results in order to improve the quality of CPX items. In addition, we intended to explore statistical procedures in order to merge examination data from several different medical schools.
METHODS The subject of the study was the 2005 CPX examination data from 10 medical schools located in Seoul and the Kyunggi province. For merging data from ten different medical schools, Levene's test for homogeneity of variances was used. Homogeneous group selection was conducted based on ANOVA or Kruskal-Wallis' test and Tukey's multiple comparisons appropriately. The generalized partial credit model was applied to analyze polytomous items and the 2-parameter logistic model was used to analyze dichotomous items.
RESULTS Data from 8 medical schools were incorporated into the analysis. The result of the discrimination index by IRT was different from that of CTT in both polytomous and dichotomous items. Discrimination index from IRT tended to be lower than that of CTT. Difficulty index of dichotomous items of two models was correlated well with each other.
However, for polytomous items, IRT model provided more information than CCT.
CONCLUSION We discovered that the CPX items were mostly easy in terms of difficulty index, and the result from IRT and CCT model did not correlated well in the discrimination index. IRT may provide more detailed information for polytomous items, but the checklist and criteria of scoring system should be cautiously reviewed.
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PURPOSE The purpose of this study is to evaluate the accuracy of standardized patients'(SP) rating according to the order of examinees in clinical performance examination.
METHODS In the clinical performance examination which was administered in 2005 at Seoul National University College of Medicine, each SP evaluated 16 students consecutively. For all 16 SPs(2 SPs per station), accuracy of rating was evaluated by comparing the individual records of each SP to the 'recording keys' made by two SPs from reviewing a video recording of performances by examinees.
RESULTS The average number of items incorrectly rated by SP was 3.8(range, 0~12), 2.8 in female SPs and 4.8 in male SPs(p<0.001). No statistical correlation was observed between the number of errors and the order of examinees(p=0.843). Even after stratification by gender or age of the SPs or domains of examination, the number of items incorrectly rated did not differ significantly according to the order of examinees.
CONCLUSION An increase in SP's rating error with time after the start of examinations was not observed within the 16 consecutive encounters in clinical performance examination.
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The Change of CPX Scores according to Repeated CPXs Yoon Hee Lee, Jae Hyun Park, Jin Kyung Ko, Hyo Bin Yoo Korean Journal of Medical Education.2011; 23(3): 193. CrossRef
PURPOSE The purpose of this study is to assess the effects of case type and gender of standardized patient on student performance in a clinical performance examination(CPX).
METHODS During 2005, an eight-station CPX was administered to fourth-year students from 4 medical schools. A total of 306 students, of which 206(67%) were male, participated in the exam. Station checklists, scored by the SPs, consisted of history taking(Hx), physical examination(PE), information sharing(IS), clinical courtesy(CC) and patient-physician interaction(PPI). A measurement of students' perceived difficulty was obtained through student questionnaires. The difference of CPX scores between male and female students were studied using Mann-Whitney's U.
RESULTS Across the gender-neutral cases, female students scored better in Hx in 2 cases. In PE, IS and CC, the only difference seen was with CC in 1 case(female students scored higher). In PPI, female students performed better than male students in all female SP cases and one male SP case, but, there was a significant student gender-SP gender interaction when averaging all cases. For the gender sensitive case, there was no significant difference in all checklist categories in the male case when student gender was considered. In the female case, female students performed better than male students only in PPI. Student questionnaires revealed that there was no significant difference in perceived difficulty between male and female students.
RESULTS The standardized patients' ratings in gender sensitive cases are not affected by the gender of standardized patients and students, except in PPI with a female case where female students performed better than male students.
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The Correlation between CPX and Written Examination Scores in Medical Students Yera Hur, Sun Kim, Sung-Whan Park Korean Journal of Medical Education.2007; 19(4): 335. CrossRef
PURPOSE This study was designed to investigate the effects of information sharing between students on results of clinical performance examination (CPX).
METHODS 143 third-year students, who completed their core clinical clerkship, were randomly assigned to one day of a 3-day, 6 station CPX. Station checklists, scored by the SP(s), consisted of history taking, physical examination, information sharing, clinical courtesy and patient-physician interaction. We compared the CPX station scores, CPX domain scores, self assessment scores and GPA of the three groups tested on different days with ANOVA, and analyzed the differences in CPX scores, after controlling for GPA, with ANCOVA. The correlations among the CPX total and domain scores, self assessment and the GPA of the 3rd year students were calculated. Data regarding information sharing between students and self-assessment were obtained through student questionnaires.
RESULTS CPX total scores, self assessment scores and GPA of 3rd year students from day-2 were significantly higher than scores from day-1 or day-3. Checklist analysis showed that PE, CC and PPI scores were significantly higher on day-2, but Hx and IS scores were not significantly different.
Results from questionnaires showed that 43% of students shared evaluation information. And CPX total scores had little correlation with self assessment scores. GPA of 3rd year students showed a similar pattern with the CPX totalscore.
CONCLUSION There is information sharing occurring between students during clinical performance examinations. Although there are significant differences in CPXscores for the treatment group, it seemed that CPX scores are not affected by information sharing between students. Reliability of information sharing from other students is low. The generalization of this study should be interpreted carefully.
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PURPOSE Recently, the clinical performance examination (CPX) using standardized patients has been introduced to several Korean medical schools. The purpose of this paper is to evaluate the correlation of CPX scores with the scores of other clinical clerkship assessments and written examinations. METHODS: We evaluated the correlation of the scores of CPX, which was administered to third-year medical students (n=230) at Seoul National University College of Medicine in January 2005, with the scores of a slide examination in internal medicine, an objective structured clinical examination (OSCE) in pediatrics and obstetrics/gynecology, and the written examinations in internal medicine and general surgery. RESULTS: CPX scores showed a mild correlation with the scores of the slide examination in internal medicine and OSCE in pediatrics and obstetrics/gynecology (r=0.19, 0.28, 0.30). CPX scores were also mildly correlated with written examination scores in internal medicine but not associated with those in general surgery. CONCLUSION: Considering the mild correlation of CPX scores with scores of other clinical clerkship assessments and written examinations, CPX should be affirmatively considered as an examination complementary to previous examinations.
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Effects of Case Type and Standardized Patient Gender on Student Performance in a Clinical Performance Examination Jonghoon Kim, Kiyoung Lee, Dongmi Yoo, Eunbae Yang Korean Journal of Medical Education.2007; 19(1): 23. CrossRef
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PURPOSE Standardized patients participate in clinical performance examinations not only to simulate case scenarios but also to evaluate the performance of students using a checklist. The accuracy in checking off checklist items is one of the most important factors determining the reliability of this examination. The purposes of this study were to determine the SP' s overall accuracy in recording checklist items, and whether their accuracy was affected by certain characteristics of checklist items. METHODS: Three professors, who have been fully involved in scenario development and SP training, reviewed videotapes of the examination and evaluated the performance of the students using the same checklist. SP' s checklists were marked on this 'correct checklist'. The checklists and checklist guidelines of the items marked under the score of 50 out of 100 were analyzed. RESULTS: Results showed that the accuracy of the SP' s in recording checklist items was 86.9% and was affected by certain characteristics, such as complexity or ambiguity of checklists and checklist guidelines.
CONCLUSION In this study, the SP' s accuracy in recording checklist items was good to very good, and the result suggested that the accuracy could be improved by the elaboration of checklists and checklist guidelines.
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Clinical Performance Examination Utilizing Standardized Patients in Board Examination: Based on the Board Examination of Korean Neurological Association for Three Years Beom Joon Kim, Jung-Joon Sung, Hoon Ki Park, Dae-Won Seo, Chin-Sang Chung, Byung-Woo Yoon Korean Journal of Medical Education.2011; 23(2): 127. CrossRef
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The Accuracy of Standardized Patients' Rating according to the Order of Examinees in Clinical Performance Examination Wan Beom Park, Ah Reum Kim, Sung A Lee, Eun A Kim, Sun-young Chang, Yon Su Kim, Suk Wha Kim, Jwa-Seop Shin, Yoon Sung Lee Korean Journal of Medical Education.2007; 19(1): 39. CrossRef
PURPOSE To compare the evaluation results of faculties to those of Standardized Patients (SP) participating in a Clinical Performance Examination (CPX) administered at Ewha Womans University College of Medicine. METHODS: The CPX was taken by 77 fourth year medical students. Cases and checklist were developed by the medical school consortium in capital area. Six cases were used and 24 SPs participated and evaluated the students' performances. The whole session was recorded on videotapes so that 6 medical school faculties could analyze and evaluate the students' performances as well. The results were compared and analyzed by SPSS package. RESULTS: The agreement between the faculties and the SPs was relatively good (r=0.79), but not good enough. In every case, SPs gave higher marks than did the faculties. Clear disease entity cases like "hepatitis" and "anemia" showed better agreement than obscure clinical contexts such as "bad news delivery". Better agreement was seen in the items of physical exam category (r=0.91), but the agreement was very poor in the items of doctor-patient (Dr-Pt) relationship category (r=0.54). The construction of checklist and the character of each evaluation item should influence the differences. CONCLUSION: More detailed guidelines and clear/specific evaluating items are necessary to improve the agreement rate. In certain categories like physical exam and brief history taking, the SP' s evaluation can replace the faculties', but for complex contexts like Dr-Pt relationship.
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Content Analysis of Standardized-Patients' Descriptive Feedback on Student Performance on the CPX Young Hee Lee, Young-Mee Lee, Byung Soo Kim Korean Journal of Medical Education.2010; 22(4): 291. CrossRef
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The Correlation between CPX and Written Examination Scores in Medical Students Yera Hur, Sun Kim, Sung-Whan Park Korean Journal of Medical Education.2007; 19(4): 335. CrossRef
PURPOSE The purpose of the study is to analyse the appropriateness of using standardized patients' (SPs) assessment scores of medical students in clinical performance examination (CPX). METHODS: 110 fourth year medical students in year four were divided into two large groups (group A and group B). Each group of students performed four different cases and overall, eight cases were tested. The examination were done by professors and the SPs using the same examination paper. Test scores were analysed per station and per each test domain. The differences between the two examiners were studied using paired t-test.
RESULTS There were significant differences in the scores given out by the professors' and the SP' s in four out of the eight stations. According to the examination results of each domain, four cases showed significant differences in the history taking category, three cases in the physical examination, one case in the information sharing, four cases in clinical courtesy, and two cases in physician-patient relationship category. Cronbach' s alpha scores of all stations were over 0.6, reflecting that the test items were appropriate for the examination. CONCLUSION: From the result of this study and according to many preceding studies, using SPs' evaluation scores in CPX is appropriate. Some limitation of this study and ideas for improvement in using SPs in CPX are suggested.
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The Correlation between CPX and Written Examination Scores in Medical Students Yera Hur, Sun Kim, Sung-Whan Park Korean Journal of Medical Education.2007; 19(4): 335. CrossRef
PURPOSE This study aims to abstract the differences of scores between the clinical instructors and standardized patients (SPs) in a clinical performance examination (CPX) using SPs and to correlate the concordance between the evaluation scores and the school records. METHODS: The CPX was administered in 2003 to a total of thirty-six fifth year medical students at Gachon Medical School. The examination consisted of four cases, and four stations were duplicated, each requiring a total of 7.5 minutes per station.
Evaluation of the student' s performances was conducted by both clinical instructors and SPs using a formatted checklist. Results were analysed by t-test, agreement rates, and Pearson correlation. RESULT: The mean scores given out by the clinical instructors and the SPs for the newly developed case were significantly different, while those scores for pre-existing cases were not in the old cases. The correlation coefficients between these two evaluation groups were relatively high. And agreements between the two evaluation groups were 0.37~0.72. The mean scores among clinical instructors were not significantly different, but the correlation coefficients and agreement rates were relatively high. The correlation between the evaluation scores and school records did not correlate significantly.
CONCLUSION It is concluded that the CPX is a useful tool to measure the students' essential competences in areas of knowledge, skills and attitude during the subinternship stage. In conducting a successful CPX, it is crucial to reconsider the recycling of cases and the selection and training of SPs aside from the development of an objective checklist.
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PURPOSE Analysis of the evaluation for clinical performance examination (CPX) using standardized patient (SP) in one medical school was done to compare the evaluations between the staffs and SPs, among the staffs, and among the SPs, and to investigate the correlation between the evaluation scores and the school record. METHODS: Clinical performance examination was done to seventy-nine 4th grade medical students. Checklist was modified from the existing reference and added more items. Three SPs who were non-physician volunteers were trained by authors about what is the disease and how to act the patient and how to evaluate the students.
Three staffs and three SPs both filled up the checklist at the same time right after each student's performance.
RESULTS Agreements between the staffs and the SPs were relatively high enough in the items of physical examination and management but low in the history taking related items although they were statistically significant. In the evaluation between the staffs and the SPs, the mean scores in the management and overall attitude were not significantly different, but, mean scores in the history taking, physical examination and overall skill were significantly different. Among the staffs there were no significant differences in history taking, physical examination, overall attitude, and there were significant differences in patient management and overall skill. Among the SPs there were no significant differences in physical exam, patient management and overall skill, and there were significant differences in history taking and overall attitude. The correlation coefficients between the evaluation scores and school records, between the evaluation scores and written report were relatively low respectively. CONCLUSION: To increase the agreement rates between the staffs and SPs, more training for the staffs and SPs are necessary
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BACKGROUND Evaluation of clinical performance is an essential area of Medical Licensure Examination. Yet, clinical skills has been neither uniformly well taught nor adequately assessed. This study was done as a part of preliminary study to introduce clinical performance assessment to Korean Medical Licensure Examination. The goals of this study were to identify the potential logistic problems and to examine the feasibility of OSCE to Medical Licensure Examination.
METHODS 48 minutes long OSCE, which consist of eight 5-minute stations, was developed. The same examination was administered to students over a four-week period.
RESULTS Total 26 volunteer fourth-year medical students were tested. 11 students were examined at the first administration and the rest of them were evaluated four-week later. Cronbach alpha of the total stations was 0.52. Any big administration problems were not revealed. There was no significant total score difference between early examinee and later ones. Students evaluated the OSCE contents and process positively.
CONCLUSION To acquire more reliable and valid examination, we need to develop more objective checklist and evaluator and SP training.
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