Journal of Educational Evaluation for Health Professions

Volume 21; 2024

Review

Attraction and achievement as two attributes of gamification in healthcare: an evolutionary concept analysis: Hyun Kyoung Kim; J Educ Eval Health Prof. 2024;21:10. Published online April 11, 2024; DOI: https://doi.org/10.3352/jeehp.2024.21.10 [Epub ahead of print]

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Abstract PDF: Purpose
This study conducted a conceptual analysis of gamification in healthcare utilizing Rogers' evolutionary concept analysis methodology to identify its attributes and provide a method for its applications in the healthcare field. Gamification has recently been used as a health intervention and education method, but the concept is used inconsistently and confusingly.
Methods
A literature review was conducted to derive definitions, surrogate terms, antecedents, influencing factors, attributes (characteristics with dimensions and features), surrogate concepts, consequences, implications, and hypotheses from various academic fields. A total of 56 journal articles in English and Korean, published between August 2 and August 7, 2023, were extracted from databases such as PubMed Central, the Institute of Electrical and Electronics Engineers, the Association for Computing Machinery Digital Library, the Research Information Sharing Service , and the Korean Studies Information Service System, using the keywords “gamification” and “healthcare.” These articles were then analyzed.
Results
Gamification in healthcare is defined as the application of game elements in health-related contexts to improve health outcomes. The attributes of this concept were categorized into two main areas: attraction and achievement. These categories encompass various strategies for synchronization, enjoyable engagement, visual rewards, and goal-reinforcing frames.
Conclusion
Through a multidisciplinary analysis of the concept's attributes and influencing factors, this paper provides practical strategies for implementing gamification in health interventions. When developing a gamification strategy, healthcare providers can reference this analysis to ensure the game elements are used both appropriately and effectively.

Editorial

Generative artificial intelligence platforms emerging in 2023, journal metrics, appreciation to reviewers and volunteers, and obituary: Sun Huh; J Educ Eval Health Prof. 2024;21:9. Published online April 11, 2024; DOI: https://doi.org/10.3352/jeehp.2024.21.9 [Epub ahead of print]

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Research articles

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 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 evaluators 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.

Development and psychometric evaluation of a 360-degree evaluation instrument to assess medical students’ performance in clinical settings at the emergency medicine department in Iran: a methodological study: Golnaz Azami, Sanaz Aazami, Boshra Ebrahimy, Payam Emami; J Educ Eval Health Prof. 2024;21:7. Published online April 1, 2024; DOI: https://doi.org/10.3352/jeehp.2024.21.7

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Abstract PDF Supplementary Material: Background
In the Iranian context, no 360-degree evaluation tool has been developed to assess the performance of prehospital medical emergency students in clinical settings. This article describes the development of a 360-degree evaluation tool and presents its first psychometric evaluation.
Methods
There were 2 steps in this study: step 1 involved developing the instrument (i.e., generating the items) and step 2 constituted the psychometric evaluation of the instrument. We performed exploratory and confirmatory factor analyses and also evaluated the instrument’s face, content, and convergent validity and reliability.
Results
The instrument contains 55 items across 6 domains, including leadership, management, and teamwork (19 items), consciousness and responsiveness (14 items), clinical and interpersonal communication skills (8 items), integrity (7 items), knowledge and accountability (4 items), and loyalty and transparency (3 items). The instrument was confirmed to be a valid measure, as the 6 domains had eigenvalues over Kaiser’s criterion of 1 and in combination explained 60.1% of the variance (Bartlett’s test of sphericity [1,485]=19,867.99, P<0.01). Furthermore, this study provided evidence for the instrument’s convergent validity and internal consistency (α=0.98), suggesting its suitability for assessing student performance.
Conclusion
We found good evidence for the validity and reliability of the instrument. Our instrument can be used to make future evaluations of student performance in the clinical setting more structured, transparent, informative, and comparable.

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: 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.

Research articles

Discovering social learning ecosystems during clinical clerkship from United States medical students’ feedback encounters: a content analysis: Anna Therese Cianciolo, Heeyoung Han, Lydia Anne Howes, Debra Lee Klamen, Sophia Matos; J Educ Eval Health Prof. 2024;21:5. Published online February 28, 2024; DOI: https://doi.org/10.3352/jeehp.2024.21.5

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Abstract PDF Supplementary Material: Purpose
We examined United States medical students’ self-reported feedback encounters during clerkship training to better understand in situ feedback practices. Specifically, we asked: Who do students receive feedback from, about what, when, where, and how do they use it? We explored whether curricular expectations for preceptors’ written commentary aligned with feedback as it occurs naturalistically in the workplace.
Methods
This study occurred from July 2021 to February 2022 at Southern Illinois University School of Medicine. We used qualitative survey-based experience sampling to gather students’ accounts of their feedback encounters in 8 core specialties. We analyzed the who, what, when, where, and why of 267 feedback encounters reported by 11 clerkship students over 30 weeks. Code frequencies were mapped qualitatively to explore patterns in feedback encounters.
Results
Clerkship feedback occurs in patterns apparently related to the nature of clinical work in each specialty. These patterns may be attributable to each specialty’s “social learning ecosystem”—the distinctive learning environment shaped by the social and material aspects of a given specialty’s work, which determine who preceptors are, what students do with preceptors, and what skills or attributes matter enough to preceptors to comment on.
Conclusion
Comprehensive, standardized expectations for written feedback across specialties conflict with the reality of workplace-based learning. Preceptors may be better able—and more motivated—to document student performance that occurs as a natural part of everyday work. Nurturing social learning ecosystems could facilitate workplace-based learning such that, across specialties, students acquire a comprehensive clinical skillset appropriate for graduation.

ChatGPT (GPT-4) passed the Japanese National License Examination for Pharmacists in 2022, answering all items including those with diagrams: a descriptive study: Hiroyasu Sato, Katsuhiko Ogasawara; J Educ Eval Health Prof. 2024;21:4. Published online February 28, 2024; DOI: https://doi.org/10.3352/jeehp.2024.21.4

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Abstract PDF Supplementary Material: Purpose
The objective of this study was to assess the performance of ChatGPT (GPT-4) on all items, including those with diagrams, in the Japanese National License Examination for Pharmacists (JNLEP) and compare it with the previous GPT-3.5 model’s performance.
Methods
The 107th JNLEP, conducted in 2022, with 344 items input into the GPT-4 model, was targeted for this study. Separately, 284 items, excluding those with diagrams, were entered into the GPT-3.5 model. The answers were categorized and analyzed to determine accuracy rates based on categories, subjects, and presence or absence of diagrams. The accuracy rates were compared to the main passing criteria (overall accuracy rate ≥62.9%).
Results
The overall accuracy rate for all items in the 107th JNLEP in GPT-4 was 72.5%, successfully meeting all the passing criteria. For the set of items without diagrams, the accuracy rate was 80.0%, which was significantly higher than that of the GPT-3.5 model (43.5%). The GPT-4 model demonstrated an accuracy rate of 36.1% for items that included diagrams.
Conclusion
Advancements that allow GPT-4 to process images have made it possible for LLMs to answer all items in medical-related license examinations. This study’s findings confirm that ChatGPT (GPT-4) possesses sufficient knowledge to meet the passing criteria.

Development and validity evidence for the resident-led large group teaching assessment instrument in the United States: a methodological study: Ariel Shana Frey-Vogel, Kristina Dzara, Kimberly Anne Gifford, Yoon Soo Park, Justin Berk, Allison Heinly, Darcy Wolcott, Daniel Adam Hall, Shannon Elliott Scott-Vernaglia, Katherine Anne Sparger, Erica Ye-pyng Chung; J Educ Eval Health Prof. 2024;21:3. Published online February 23, 2024; DOI: https://doi.org/10.3352/jeehp.2024.21.3

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Abstract PDF Supplementary Material: Purpose
Despite educational mandates to assess resident teaching competence, limited instruments with validity evidence exist for this purpose. Existing instruments do not allow faculty to assess resident-led teaching in a large group format or whether teaching was interactive. This study gathers validity evidence on the use of the Resident-led Large Group Teaching Assessment Instrument (Relate), an instrument used by faculty to assess resident teaching competency. Relate comprises 23 behaviors divided into 6 elements: learning environment, goals and objectives, content of talk, promotion of understanding and retention, session management, and closure.
Methods
Messick’s unified validity framework was used for this study. Investigators used video recordings of resident-led teaching from 3 pediatric residency programs to develop Relate and a rater guidebook. Faculty were trained on instrument use through frame-of-reference training. Resident teaching at all sites was video-recorded during 2018–2019. Two trained faculty raters assessed each video. Descriptive statistics on performance were obtained. Validity evidence sources include: rater training effect (response process), reliability and variability (internal structure), and impact on Milestones assessment (relations to other variables).
Results
Forty-eight videos, from 16 residents, were analyzed. Rater training improved inter-rater reliability from 0.04 to 0.64. The Φ-coefficient reliability was 0.50. There was a significant correlation between overall Relate performance and the pediatric teaching Milestone (r=0.34, P=0.019).
Conclusion
Relate provides validity evidence with sufficient reliability to measure resident-led large-group teaching competence.

Editorial

Presidential address 2024: the expansion of computer-based testing to numerous health professions licensing examinations in Korea, preparation of computer-based practical tests, and adoption of the medical metaverse: Hyunjoo Pai; J Educ Eval Health Prof. 2024;21:2. Published online February 20, 2024; DOI: https://doi.org/10.3352/jeehp.2024.21.2

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Research article

Importance, performance frequency, and predicted future importance of dietitians’ jobs by practicing dietitians in Korea: a survey study: Cheongmin Sohn, Sooyoun Kwon, Won Gyoung Kim, Kyung-Eun Lee, Sun-Young Lee, Seungmin Lee; J Educ Eval Health Prof. 2024;21:1. Published online January 2, 2024; DOI: https://doi.org/10.3352/jeehp.2024.21.1

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Abstract PDF Supplementary Material: Purpose
This study aimed to explore the perceptions held by practicing dietitians of the importance of their tasks performed in current work environments, the frequency at which those tasks are performed, and predictions about the importance of those tasks in future work environments.
Methods
This was a cross-sectional survey study. An online survey was administered to 350 practicing dietitians. They were asked to assess the importance, performance frequency, and predicted changes in the importance of 27 tasks using a 5-point scale. Descriptive statistics were calculated, and the means of the variables were compared across categorized work environments using analysis of variance.
Results
The importance scores of all surveyed tasks were higher than 3.0, except for the marketing management task. Self-development, nutrition education/counseling, menu planning, food safety management, and documentation/data management were all rated higher than 4.0. The highest performance frequency score was related to documentation/data management. The importance scores of all duties, except for professional development, differed significantly by workplace. As for predictions about the future importance of the tasks surveyed, dietitians responded that the importance of all 27 tasks would either remain at current levels or increase in the future.
Conclusion
Twenty-seven tasks were confirmed to represent dietitians’ job functions in various workplaces. These tasks can be used to improve the test specifications of the Korean Dietitian Licensing Examination and the curriculum of dietetic education programs.

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