Journal of Educational Evaluation for Health Professions

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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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

Citations to this article as recorded by

Using the OSCE to assess medical students’ communication and clinical reasoning during five years of restricted clinical practice
Armijo-Rivera Soledad, Zamorano Saavedra Catalina, Vicencio-Clarke Scarlett, Behrens Pérez Claudia, Pérez-Villalobos Cristhian
BMC Medical Education.2025;[Epub] CrossRef
Future doctors’ silence: An empirical study of declining speaking-up behavior among medical students
Hui-Wen Chen, Yi-Chun Chen, Hung-Wei Tsai, Enoch Yi-No Kang, Jen-Chieh Wu, S. Barry Issenberg
Medical Teacher.2025; : 1. CrossRef
Effect of training content and environmental factors on resident retention rates in postgraduate year programs
Hsiao-Chin Shen, Pei-Chi Huang, Mei-Lien Pan, Ching-Wen Yang, Chia Chen Ma, Shin-Yu Tsai, Hsiao-Yun Yeh, Yi-Hsuan Lin, Ying-Ying Yang, Shuu-Jiun Wang
Journal of the Chinese Medical Association.2025; 88(12): 949. CrossRef
The emergence of generative artificial intelligence platforms in 2023, journal metrics, appreciation to reviewers and volunteers, and obituary
Sun Huh
Journal of Educational Evaluation for Health Professions.2024; 21: 9. 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

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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.

Brief report

Effects of a simulation-based blended training model on nurses’ treatment decision-related knowledge about oral cancer in Taiwan: a pilot survey: Chia-Chang Huang, Shiau-Shian Huang, Ying-Ying Yang, Shou-Yen Kao; J Educ Eval Health Prof. 2021;18:10. Published online May 25, 2021; DOI: https://doi.org/10.3352/jeehp.2021.18.10

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Abstract PDF Supplementary Material

The present study aimed to evaluate the effects of virtual reality (VR) simulations combined with bedside assignments on nurses’ self-efficacy in providing pre-treatment educational services. Between March 2019 and November 2020, we conducted a study of VR educational materials that were developed to cover information about the treatment of oral cancers. The effects of the VR simulation, the thinking-path tracking map method, and bedside assignments on the nurses’ treatment decision-related knowledge were evaluated in a ward for oral cancer patients at Taipei Veterans General Hospital, Taipei, Taiwan. The blended training model significantly increased nurses’ familiarity (P<0.01) and confidence (P<0.03) regarding their knowledge of treatments and treatment decision-related knowledge. This model also significantly increased their confidence in their skills in bedside pre-treatment education for admitted oral cancer patients (P<0.002). Oral cancer-specific VR materials enhanced the effectiveness of skills training among nurses in the oral cancer ward.

Citations

Citations to this article as recorded by

The use of simulation-based education in cancer care: a scoping review
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International Journal of Healthcare Simulation.2023;[Epub] CrossRef
Application of computer-based testing in the Korean Medical Licensing Examination, the emergence of the metaverse in medical education, journal metrics and statistics, and appreciation to reviewers and volunteers
Sun Huh
Journal of Educational Evaluation for Health Professions.2022; 19: 2. CrossRef
Assessing the Financial Sustainability of High-Fidelity and Virtual Reality Simulation for Nursing Education
Michael D. Bumbach, Beth A. Culross, Santanu K. Datta
CIN: Computers, Informatics, Nursing.2022; 40(9): 615. CrossRef

Research articles

Effects of virtual reality training on decreasing the rates of needlestick or sharp injury in new-coming medical and nursing interns in Taiwan: Szu-Hsien Wu, Chia-Chang Huang, Shiau-Shian Huang, Ying-Ying Yang, Chih-Wei Liu, Boaz Shulruf, Chen-Huan Chen; J Educ Eval Health Prof. 2020;17:1. Published online January 20, 2020; DOI: https://doi.org/10.3352/jeehp.2020.17.1

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Abstract PDF Supplementary Material

Purpose
Senior nursing and medical interns’ lack of familiarity and confidence with respect to practicing universal precaution for the prevention of occupational needlestick or sharp injuries may harm themselves. Trainees’ self-reported needlestick or sharp injury rate was known to be especially high during the first 2 months of internship in Taiwan. This prospective cohort study aimed to assess the effect of newly developed virtual reality (VR) game, which uses Gagne’s learning model to improve universal precaution for needlestick or sharp injury prevention and decrease the rates of needle stick or sharp injuries in new-coming medical and nursing interns in Taiwan.
Methods
From 2017 to 2019, the VR system was developed and applied in training of 59 new-coming nursing and 50 medical interns. Occupational needlestick or sharp injury prevention was sought to be achieved through a game of right and wrong choices for safe or unsafe universal precaution behaviors.
Results
In comparison with medical interns, a higher proportion of nursing interns had past experiences of deep occupational needlestick or sharp injury. Before VR training, the familiarity and confidence for needlestick or sharp injury prevention were higher among nursing interns than medical interns. Trainees with past experiences of deep needlestick or sharp injury exhibited better performance on the accuracy rate and time needed to complete 20 decisions than those without past experiences in VR practice. All trainees showed an improved performance after VR training. A high proportion of trainees reported that the VR-based training significantly decreased their anxiety about needlestick or sharp injury prevention.
Conclusion
This self-developed VR game system using Gagne’s flow improved universal precaution for needlestick or sharp injury prevention and reduced the needlestick or sharp injury rates in the first 2 months of nursing and medical internship.

Citations

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Esmaeil Mehraeen, Mohsen Dashti, Pegah Mirzapour, Afsaneh Ghasemzadeh, Shima Jahani, Amir Masoud Afsahi, Sina Mohammadi, Fatemeh Khajeh Akhtaran, Mohammad Mehrtak, SeyedAhmad SeyedAlinaghi
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Dreyfus scale-based feedback increased medical students’ satisfaction with the complex cluster part of a interviewing and physical examination course and improved skills readiness in Taiwan: Shiau-Shian Huang, Chia-Chang Huang, Ying-Ying Yang, Shuu-Jiun Wang, Boaz Shulruf, Chen-Huan Chen; J Educ Eval Health Prof. 2019;16:30. Published online October 11, 2019; DOI: https://doi.org/10.3352/jeehp.2019.16.30

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Abstract PDF Supplementary Material: Purpose
In contrast to the core part of the clinical interviewing and physical examination (PE) skills course, corresponding to the basic, head-to-toe, and thoracic systems, learners need structured feedback in the cluster part of the course, which includes the abdominal, neuromuscular, and musculoskeletal systems. This study evaluated the effects of using Dreyfus scale-based feedback, which has elements of continuous professional development, instead of Likert scale-based feedback in the cluster part of training in Taiwan.
Methods
Instructors and final-year medical students in the 2015–2016 classes of National Yang-Ming University, Taiwan comprised the regular cohort, whereas those in the 2017–2018 classes formed the intervention cohort. In the intervention cohort, Dreyfus scale-based feedback, rather than Likert scale-based feedback, was used in the cluster part of the course.
Results
In the cluster part of the course in the regular cohort, pre-trained standardized patients rated the class climate as poor, and students expressed low satisfaction with the instructors and course and low self-assessed readiness. In comparison with the regular cohort, improved end-of-course group objective structured clinical examination scores after the cluster part were noted in the intervention cohort. In other words, the implementation of Dreyfus scale-based feedback in the intervention cohort for the cluster part improved the deficit in this section of the course.
Conclusion
The implementation of Dreyfus scale-based feedback helped instructors to create a good class climate in the cluster part of the clinical interviewing and PE skills course. Simultaneously, this new intervention achieved the goal of promoting medical students’ readiness for interviewing, PE, and self-directed learning.

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