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.

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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.

Medical students’ self-assessed efficacy and satisfaction with training on endotracheal intubation and central venous catheterization with smart glasses in Taiwan: a non-equivalent control-group pre- and post-test study: Yu-Fan Lin, Chien-Ying Wang, Yen-Hsun Huang, Sheng-Min Lin, Ying-Ying Yang; J Educ Eval Health Prof. 2022;19:25. Published online September 2, 2022; DOI: https://doi.org/10.3352/jeehp.2022.19.25

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Abstract PDF Supplementary Material

Purpose
Endotracheal intubation and central venous catheterization are essential procedures in clinical practice. Simulation-based technology such as smart glasses has been used to facilitate medical students’ training on these procedures. We investigated medical students’ self-assessed efficacy and satisfaction regarding the practice and training of these procedures with smart glasses in Taiwan.
Methods
This observational study enrolled 145 medical students in the 5th and 6th years participating in clerkships at Taipei Veterans General Hospital between October 2020 and December 2021. Students were divided into the smart glasses or the control group and received training at a workshop. The primary outcomes included students’ pre- and post-intervention scores for self-assessed efficacy and satisfaction with the training tool, instructor’s teaching, and the workshop.
Results
The pre-intervention scores for self-assessed efficacy of 5th- and 6th-year medical students in endotracheal intubation and central venous catheterization procedures showed no significant difference. The post-intervention score of self-assessed efficacy in the smart glasses group was better than that of the control group. Moreover, 6th-year medical students in the smart glasses group showed higher satisfaction with the training tool, instructor’s teaching, and workshop than those in the control group.
Conclusion
Smart glasses served as a suitable simulation tool for endotracheal intubation and central venous catheterization procedures training in medical students. Medical students practicing with smart glasses showed improved self-assessed efficacy and higher satisfaction with training, especially for procedural steps in a space-limited field. Simulation training on procedural skills with smart glasses in 5th-year medical students may be adjusted to improve their satisfaction.

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A narrative review of advancing medical education through technology: the role of smart glasses in situated learning
Bahareh Ghavami Hosein Pour, Zahra Karimian, Nazanin Hatami Niya
BMC Medical Education.2025;[Epub] CrossRef
Improvement of the Endotracheal Intubation Skill of Nurse Anesthesia Students Using Visual Self-evaluation in Iran: A Randomized Controlled Study
Mahdieh Parhizkar, Ali Khalafi, Masoumeh Albooghobeish, Nooshin Sarvi-Sarmeydani
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The use of smart glasses in nursing education: A scoping review
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Comparison between residents with a 6-year medical program and a 7-year medical program in terms of objective structured clinical examination performance in postgraduate year training in Taiwan: a 2-group pre- and post-test non-synchronized study: Ya-Ting Chang, Ying-Ying Yang, Chung-Pin Li, Chen-Huan Chen; J Educ Eval Health Prof. 2022;19:13. Published online June 24, 2022; DOI: https://doi.org/10.3352/jeehp.2022.19.13

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Abstract PDF Supplementary Material

Purpose
In 2013, medical schools in Taiwan implemented a 6-year medical program that replaced the previous 7-year medical education program. The postgraduate year (PGY) program was also extended from 1 year to 2 years. The new program is characterized by diversified teaching, integration of medical skills, a system-oriented curriculum, and the implementation of primary care and clinical thinking training. The purpose of this study was to examine whether postgraduate residents who learned under the new program have better patient care skills than those who learned under the previous program.
Methods
Of 101 residents in the PGY program at Taipei Veterans General Hospital, 78 were trained in the 6-year program, while 23 were trained in the 7-year program. During the PGY training, 2 objective structured clinical examinations (OSCEs) were used to evaluate clinical reasoning, communication skills, and procedural skills at the beginning of the training and after 11 months of training, respectively. The scores of each OSCE and the rate of improvement of the pre- and post-tests were analyzed.
Results
Residents trained in the new program scored higher on clinical reasoning (P<0.001) and the total scores of the 3 tested skills (P=0.019) on the pre-test. In terms of improvement, residents educated in the previous system improved more in clinical reasoning than those educated in the new education system.
Conclusion
The new medical education program, which emphasizes clinical thinking, improved residents’ clinical skills. The PGY program was effective in improving the clinical performance of residents who were educated in the previous system.

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Addressing Burnout Problems among Postgraduate Trainee Doctors
Lien-Chung Wei
Taiwanese Journal of Psychiatry.2023; 37(2): 96. CrossRef

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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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.

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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.

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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.

An expert-led and artificial intelligence system-assisted tutoring course to improve the confidence of Chinese medical interns in suturing and ligature skills: a prospective pilot study: Ying-Ying Yang, Boaz Shulruf; J Educ Eval Health Prof. 2019;16:7. Published online April 10, 2019; DOI: https://doi.org/10.3352/jeehp.2019.16.7

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Abstract PDF Supplementary Material

Purpose
Lack of confidence in suturing/ligature skills due to insufficient practice and assessments is common among novice Chinese medical interns. This study aimed to improve the skill acquisition of medical interns through a new intervention program.
Methods
In addition to regular clinical training, expert-led or expert-led plus artificial intelligence (AI) system tutoring courses were implemented during the first 2 weeks of the surgical block. Interns could voluntarily join the regular (no additional tutoring), expert-led tutoring, or expert-led+AI tutoring groups freely. In the regular group, interns (n=25) did not receive additional tutoring. The expert-led group received 3-hour expert-led tutoring and in-training formative assessments after 2 practice sessions. After a similar expert-led course, the expert-led+AI group (n=23) practiced and assessed their skills on an AI system. Through a comparison with the internal standard, the system automatically recorded and evaluated every intern’s suturing/ligature skills. In the expert-led+AI group, performance and confidence were compared between interns who participated in 1, 2, or 3 AI practice sessions.
Results
The end-of-surgical block objective structured clinical examination (OSCE) performance and self-assessed confidence in suturing/ligature skills were highest in the expert-led+AI group. In comparison with the expert-led group, the expert-led+AI group showed similar performance in the in-training assessment and greater improvement in the end-of-surgical block OSCE. In the expert-led+AI group, the best performance and highest post-OSCE confidence were noted in those who engaged in 3 AI practice sessions.
Conclusion
This pilot study demonstrated the potential value of incorporating an additional expert-led+AI system–assisted tutoring course into the regular surgical curriculum.

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