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Research article
Inter-rater reliability and content validity of the measurement tool for portfolio assessments used in the Introduction to Clinical Medicine course at Ewha Womans University College of Medicine: a methodological study  
Dong-Mi Yoo, Jae Jin Han
J Educ Eval Health Prof. 2024;21:39.   Published online December 10, 2024
DOI: https://doi.org/10.3352/jeehp.2024.21.39
  • 4,824 View
  • 259 Download
  • 1 Web of Science
  • 2 Crossref
AbstractAbstract PDFSupplementary Material
Purpose
This study aimed to examine the reliability and validity of a measurement tool for portfolio assessments in medical education. Specifically, it investigated scoring consistency among raters and assessment criteria appropriateness according to an expert panel.
Methods
A cross-sectional observational study was conducted from September to December 2018 for the Introduction to Clinical Medicine course at the Ewha Womans University College of Medicine. Data were collected for 5 randomly selected portfolios scored by a gold-standard rater and 6 trained raters. An expert panel assessed the validity of 12 assessment items using the content validity index (CVI). Statistical analysis included Pearson correlation coefficients for rater alignment, the intraclass correlation coefficient (ICC) for inter-rater reliability, and the CVI for item-level validity.
Results
Rater 1 had the highest Pearson correlation (0.8916) with the gold-standard rater, while Rater 5 had the lowest (0.4203). The ICC for all raters was 0.3821, improving to 0.4415 after excluding Raters 1 and 5, indicating a 15.6% reliability increase. All assessment items met the CVI threshold of ≥0.75, with some achieving a perfect score (CVI=1.0). However, items like “sources” and “level and degree of performance” showed lower validity (CVI=0.72).
Conclusion
The present measurement tool for portfolio assessments demonstrated moderate reliability and strong validity, supporting its use as a credible tool. For a more reliable portfolio assessment, more faculty training is needed.

Citations

Citations to this article as recorded by  
  • Values Education in Curriculum Reform: A Qualitative Document Analysis of the Türkiye Century Maarif Model for Primary Education
    Ethem Gürhan
    Journal of Educational Research and Practice.2026; 4(1): 24.     CrossRef
  • On the quantitative analysis of assessment scores with implicit and explicit constraints
    Sanjeeb Shrestha, Xiaoying Kong, Paul Kwan
    Studies in Educational Evaluation.2025; 87: 101509.     CrossRef
Case Study
Feasibility of utilizing functional near-infrared spectroscopy to measure the cognitive load of paramedicine students undertaking high-acuity clinical simulations in Australia: a case study  
Jason Betson, Erich Christian Fein, David Long, Peter Horrocks
J Educ Eval Health Prof. 2024;21:38.   Published online December 10, 2024
DOI: https://doi.org/10.3352/jeehp.2024.21.38
  • 2,855 View
  • 175 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract PDFSupplementary Material
Purpose
Paramedicine education often uses high-fidelity simulations that mimic real-life emergencies. These experiences can trigger stress responses characterized by physiological changes, including alterations in cerebral blood flow and oxygenation. Functional near-infrared spectroscopy (fNIRS) is emerging as a promising tool for assessing cognitive stress in educational settings.
Methods
Eight final-year undergraduate paramedicine students completed 2 high-acuity scenarios 7 days apart. Real-time continuous recording of cerebral blood flow and oxygenation levels in the prefrontal cortex was undertaken via fNIRS as a means of assessing neural activity during stressful scenarios.
Results
fNIRS accurately determined periods of increased cerebral oxygenation when participants were undertaking highly technical skills or making significant clinical decisions.
Conclusion
fNIRS holds potential for objectively measuring the cognitive load in undergraduate paramedicine students. By providing real-time insights into neurophysiological responses, fNIRS may enhance training outcomes in paramedicine programs and improve student well-being (Australian New Zealand Clinical Trials Registry: ACTRN12623001214628).

Citations

Citations to this article as recorded by  
  • Effect of repeating simulated high-stress scenario assessments on paramedicine student performance and psychophysiological response
    Jason Betson, Erich C. Fein, David Long, Peter Horrocks
    Interactive Learning Environments.2025; : 1.     CrossRef
  • Relationships between cognitive appraisals of threat and challenge, psychophysiological responses, and clinical performance during high-stress simulated osces
    Jason Betson, Erich C. Fein, David Long, Peter Horrocks
    BMC Medical Education.2025;[Epub]     CrossRef
Review
How to review and assess a systematic review and meta-analysis article: a methodological study (secondary publication)  
Seung-Kwon Myung
J Educ Eval Health Prof. 2023;20:24.   Published online August 27, 2023
DOI: https://doi.org/10.3352/jeehp.2023.20.24
  • 37,853 View
  • 1,512 Download
  • 58 Web of Science
  • 57 Crossref
AbstractAbstract PDFSupplementary Material
Systematic reviews and meta-analyses have become central in many research fields, particularly medicine. They offer the highest level of evidence in evidence-based medicine and support the development and revision of clinical practice guidelines, which offer recommendations for clinicians caring for patients with specific diseases and conditions. This review summarizes the concepts of systematic reviews and meta-analyses and provides guidance on reviewing and assessing such papers. A systematic review refers to a review of a research question that uses explicit and systematic methods to identify, select, and critically appraise relevant research. In contrast, a meta-analysis is a quantitative statistical analysis that combines individual results on the same research question to estimate the common or mean effect. Conducting a meta-analysis involves defining a research topic, selecting a study design, searching literature in electronic databases, selecting relevant studies, and conducting the analysis. One can assess the findings of a meta-analysis by interpreting a forest plot and a funnel plot and by examining heterogeneity. When reviewing systematic reviews and meta-analyses, several essential points must be considered, including the originality and significance of the work, the comprehensiveness of the database search, the selection of studies based on inclusion and exclusion criteria, subgroup analyses by various factors, and the interpretation of the results based on the levels of evidence. This review will provide readers with helpful guidance to help them read, understand, and evaluate these articles.

Citations

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    International Immunopharmacology.2025; 145: 113682.     CrossRef
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    The Journal of Clinical Endocrinology & Metabolism.2025; 110(7): 2082.     CrossRef
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    BMJ Public Health.2025; 3(1): e001161.     CrossRef
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Research articles
Implementation strategy for introducing a clinical skills examination to the Korean Oriental Medicine Licensing Examination: a mixed-method modified Delphi study  
Chan-Young Kwon, Sanghoon Lee, Min Hwangbo, Chungsik Cho, Sangwoo Shin, Dong-Hyeon Kim, Aram Jeong, Hye-Yoon Lee
J Educ Eval Health Prof. 2023;20:23.   Published online July 17, 2023
DOI: https://doi.org/10.3352/jeehp.2023.20.23
  • 4,714 View
  • 180 Download
  • 1 Crossref
AbstractAbstract PDFSupplementary Material
Purpose
This study investigated the validity of introducing a clinical skills examination (CSE) to the Korean Oriental Medicine Licensing Examination through a mixed-method modified Delphi study.
Methods
A 3-round Delphi study was conducted between September and November 2022. The expert panel comprised 21 oriental medicine education experts who were officially recommended by relevant institutions and organizations. The questionnaires included potential content for the CSE and a detailed implementation strategy. Subcommittees were formed to discuss concerns around the introduction of the CSE, which were collected as open-ended questions. In this study, a 66.7% or greater agreement rate was defined as achieving a consensus.
Results
The expert panel’s evaluation of the proposed clinical presentations and basic clinical skills suggested their priorities. Of the 10 items investigated for building a detailed implementation strategy for the introduction of the CSE to the Korean Oriental Medicine Licensing Examination, a consensus was achieved on 9. However, the agreement rate on the timing of the introduction of the CSE was low. Concerns around 4 clinical topics were discussed in the subcommittees, and potential solutions were proposed.
Conclusion
This study offers preliminary data and raises some concerns that can be used as a reference while discussing the introduction of the CSE to the Korean Oriental Medicine Licensing Examination.

Citations

Citations to this article as recorded by  
  • Program Evaluation on a Pre-clerkship Course Implementing Simulation in Korean Medical Education
    Yehun Jeong, Sung-Youl Choi, Myung-Ho Jin, Chang-Eop Kim, Ji-Hwan Kim, Hyun-Kyung Sung, Eunbyul Cho, Man-Suk Hwang, Su-Hyun Hong, Son-Hwan Choi, SeongMi Kim, Hye-Yoon Lee
    Journal of Physiology & Pathology in Korean Medicine.2025; 39(6): 158.     CrossRef
Empirical analysis comparing the tele-objective structured clinical examination and the in-person assessment in Australia  
Jonathan Zachary Felthun, Silas Taylor, Boaz Shulruf, Digby Wigram Allen
J Educ Eval Health Prof. 2021;18:23.   Published online September 23, 2021
DOI: https://doi.org/10.3352/jeehp.2021.18.23
  • 8,468 View
  • 255 Download
  • 4 Web of Science
  • 5 Crossref
AbstractAbstract PDFSupplementary Material
Purpose
It aimed to compare the use of the tele-objective structured clinical examination (teleOSCE) with in-person assessment in high-stakes clinical examination so as to determine the impact of the teleOSCE on the assessment undertaken. Discussion follows regarding what skills and domains can effectively be assessed in a teleOSCE.
Methods
This study is a retrospective observational analysis. It compares the results achieved by final year medical students in their clinical examination, assessed using the teleOSCE in 2020 (n=285), with those who were examined using the traditional in-person format in 2019 (n=280). The study was undertaken at the University of New South Wales, Australia.
Results
In the domain of physical examination, students in 2020 scored 0.277 points higher than those in 2019 (mean difference=–0.277, P<0.001, effect size=0.332). Across all other domains, there was no significant difference in mean scores between 2019 and 2020.
Conclusion
The teleOSCE does not negatively impact assessment in clinical examination in all domains except physical examination. If the teleOSCE is the future of clinical skills examination, assessment of physical examination will require concomitant workplace-based assessment.

Citations

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  • Feasibility of an online clinical assessment of competence in physiotherapy students
    Brooke Flew, Lucy Chipchase, Darren Lee, Jodie A. McClelland
    Physiotherapy Theory and Practice.2025; 41(3): 508.     CrossRef
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    Chin-Siang Ang, Sakura Ito, Jennifer Cleland
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    Satoshi Hara, Kunio Ohta, Daisuke Aono, Toshikatsu Tamai, Makoto Kurachi, Kimikazu Sugimori, Hiroshi Mihara, Hiroshi Ichimura, Yasuhiko Yamamoto, Hideki Nomura
    Advances in Health Sciences Education.2024; 29(3): 949.     CrossRef
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    Y.X. Tay, J.P. McNulty
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  • Newly appointed medical faculty members’ self-evaluation of their educational roles at the Catholic University of Korea College of Medicine in 2020 and 2021: a cross-sectional survey-based study
    Sun Kim, A Ra Cho, Chul Woon Chung
    Journal of Educational Evaluation for Health Professions.2021; 18: 28.     CrossRef
Agreement between medical students’ peer assessments and faculty assessments in advanced resuscitation skills examinations in South Korea  
Jinwoo Jeong, Song Yi Park, Kyung Hoon Sun
J Educ Eval Health Prof. 2021;18:4.   Published online March 25, 2021
DOI: https://doi.org/10.3352/jeehp.2021.18.4
  • 7,602 View
  • 303 Download
AbstractAbstract PDFSupplementary Material
Purpose
In medical education, peer assessment is considered to be an effective learning strategy. Although several studies have examined agreement between peer and faculty assessments regarding basic life support (BLS), few studies have done so for advanced resuscitation skills (ARS) such as intubation and defibrillation. Therefore, this study aimed to determine the degree of agreement between medical students’ and faculty assessments of ARS examinations.
Methods
This retrospective explorative study was conducted during the emergency medicine (EM) clinical clerkship of fourth-year medical students from April to July 2020. A faculty assessor (FA) and a peer assessor (PA) assessed each examinee’s resuscitation skills (including BLS, intubation, and defibrillation) using a checklist that consisted of 20 binary items (performed or not performed) and 1 global proficiency rating using a 5-point Likert scale. The prior examinee assessed the next examinee after feedback and training as a PA. All 54 students participated in peer assessment. The assessments of 44 FA/PA pairs were analyzed using the intraclass correlation coefficient (ICC) and Gwet’s first-order agreement coefficient.
Results
The PA scores were higher than the FA scores (mean±standard deviation, 20.2±2.5 [FA] vs. 22.3±2.4 [PA]; P<0.001). The agreement was poor to moderate for the overall checklist (ICC, 0.55; 95% confidence interval [CI], 0.31 to 0.73; P<0.01), BLS (ICC, 0.19; 95% CI, -0.11 to 0.46; P<0.10), intubation (ICC, 0.51; 95% CI, 0.26 to 0.70; P<0.01), and defibrillation (ICC, 0.49; 95% CI, 0.23 to 0.68; P<0.01).
Conclusion
Senior medical students showed unreliable agreement in ARS assessments compared to faculty assessments. If a peer assessment is planned in skills education, comprehensive preparation and sufficient assessor training should be provided in advance.
Brief Report
Clinical performance of medical students in Korea in a whole-task emergency station in the objective structured clinical examination with a standardized patient complaining of palpitations  
Song Yi Park, Hyun-Hee Kong, Min-Jeong Kim, Yoo Sang Yoon, Sang-Hwa Lee, Sunju Im, Ji-Hyun Seo
J Educ Eval Health Prof. 2020;17:42.   Published online December 16, 2020
DOI: https://doi.org/10.3352/jeehp.2020.17.42
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AbstractAbstract PDFSupplementary Material
This study assessed the clinical performance of 150 third-year medicalstudents in Busan, Korea in a whole-task emergency objective structured clinical examination station that simulated a patient with palpitations visiting the emergency department. The examination was conducted from November 25 to 27, 2019. Clinical performance was assessed as the number and percentage of students who performed history-taking (HT), a physical examination (PE), an electrocardiography (ECG) study, patient education (Ed), and clinical reasoning (CR), which were items on the checklist. It was found that 18.0% of students checked the patient’s pulse, 51.3% completed an ECG study, and 57.9% explained the results to the patient. A sizable proportion (38.0%) of students did not even attempt an ECG study. In a whole-task emergency station, students showed good performance on HT and CR, but unsatisfactory results for PE, ECG study, and Ed. Clinical skills educational programs for subjected student should focus more on PE, timely diagnostic tests, and sufficient Ed.

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  • Newly appointed medical faculty members’ self-evaluation of their educational roles at the Catholic University of Korea College of Medicine in 2020 and 2021: a cross-sectional survey-based study
    Sun Kim, A Ra Cho, Chul Woon Chung
    Journal of Educational Evaluation for Health Professions.2021; 18: 28.     CrossRef
  • Comparing the cut score for the borderline group method and borderline regression method with norm-referenced standard setting in an objective structured clinical examination in medical school in Korea
    Song Yi Park, Sang-Hwa Lee, Min-Jeong Kim, Ki-Hwan Ji, Ji Ho Ryu
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Research articles
Performance of the Ebel standard-setting method for the spring 2019 Royal College of Physicians and Surgeons of Canada internal medicine certification examination consisting of multiple-choice questions  
Jimmy Bourque, Haley Skinner, Jonathan Dupré, Maria Bacchus, Martha Ainslie, Irene W. Y. Ma, Gary Cole
J Educ Eval Health Prof. 2020;17:12.   Published online April 20, 2020
DOI: https://doi.org/10.3352/jeehp.2020.17.12
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AbstractAbstract PDFSupplementary Material
Purpose
This study aimed to assess the performance of the Ebel standard-setting method for the spring 2019 Royal College of Physicians and Surgeons of Canada internal medicine certification examination consisting of multiple-choice questions. Specifically, the following parameters were evaluated: inter-rater agreement, the correlations between Ebel scores and item facility indices, the impact of raters’ knowledge of correct answers on the Ebel score, and the effects of raters’ specialty on inter-rater agreement and Ebel scores.
Methods
Data were drawn from a Royal College of Physicians and Surgeons of Canada certification exam. The Ebel method was applied to 203 multiple-choice questions by 49 raters. Facility indices came from 194 candidates. We computed the Fleiss kappa and the Pearson correlations between Ebel scores and item facility indices. We investigated differences in the Ebel score according to whether correct answers were provided or not and differences between internists and other specialists using the t-test.
Results
The Fleiss kappa was below 0.15 for both facility and relevance. The correlation between Ebel scores and facility indices was low when correct answers were provided and negligible when they were not. The Ebel score was the same whether the correct answers were provided or not. Inter-rater agreement and Ebel scores were not significantly different between internists and other specialists.
Conclusion
Inter-rater agreement and correlations between item Ebel scores and facility indices were consistently low; furthermore, raters’ knowledge of the correct answers and raters’ specialty had no effect on Ebel scores in the present setting.

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Use of graded responsibility and common entrustment considerations among United States emergency medicine residency programs  
Jason Lai, Benjamin Holden Schnapp, David Simon Tillman, Mary Westergaard, Jamie Hess, Aaron Kraut
J Educ Eval Health Prof. 2020;17:11.   Published online April 20, 2020
DOI: https://doi.org/10.3352/jeehp.2020.17.11
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  • 4 Web of Science
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AbstractAbstract PDFSupplementary Material
Purpose
The Accreditation Council for Graduate Medical Education (ACGME) requires all residency programs to provide increasing autonomy as residents progress through training, known as graded responsibility. However, there is little guidance on how to implement graded responsibility in practice and a paucity of literature on how it is currently implemented in emergency medicine (EM). We sought to determine how EM residency programs apply graded responsibility across a variety of activities and to identify which considerations are important in affording additional responsibilities to trainees.
Methods
We conducted a cross-sectional study of EM residency programs using a 23-question survey that was distributed by email to 162 ACGME-accredited EM program directors. Seven different domains of practice were queried.
Results
We received 91 responses (56.2% response rate) to the survey. Among all domains of practice except for managing critically ill medical patients, the use of graded responsibility exceeded 50% of surveyed programs. When graded responsibility was applied, post-graduate year (PGY) level was ranked an “extremely important” or “very important” consideration between 80.9% and 100.0% of the time.
Conclusion
The majority of EM residency programs are implementing graded responsibility within most domains of practice. When decisions are made surrounding graded responsibility, programs still rely heavily on the time-based model of PGY level to determine advancement.

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Journal clubs in Australian medical schools: prevalence, application, and educators’ opinions  
Damian James Ianno, Kelly Mirowska-Allen, Stephen Anthony Kunz, Richard O’Brien
J Educ Eval Health Prof. 2020;17:9.   Published online February 26, 2020
DOI: https://doi.org/10.3352/jeehp.2020.17.9
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AbstractAbstract PDFSupplementary Material
Purpose
Medically-focused journal clubs have been used as an educational tool for over 100 years, with research indicating that they improve knowledge, reading behaviour, and critical appraisal skills. However, it is unknown how widespread they are in Australian medical schools, nor the opinions of medical education leaders as to their value.
Methods
A nationwide cross-sectional study was performed among academic leaders from every Australian medical school. Individuals were asked to complete a survey detailing their attitudes towards journal clubs using single- or multiple-answer questions, Likert scales, and ranked data. They were asked whether students at their institutions were able to partake in journal clubs, and if so, provided details on their implementation.
Results
At least 1 response was collected from 18 of 19 Australian medical schools. The response rate was 40.8% (60 of 147), and 36 responses (60.0%) were from heads of clinical schools. Respondents from 15 of 18 institutions (83.3%) stated that their institution had a journal club. Of these, 23 (65.7%) were metropolitan institutions and 12 (34.3%) were rural institutions. Eighteen (51.4%) journal clubs were clinician-led, 13 (37.1%) were run through specific hospital departments, and 23 (65.7%) occurred during clinical years. Most respondents (20 [57.1%]) stated that the primary aim of the journal club was to develop critical appraisal skills.
Conclusion
Journal clubs are a highly regarded educational tool in the armoury of medical school educators, with significant heterogeneity in their structure, geographic prevalence, and intended purpose. Further studies of their efficacy in teaching evidence-based medicine is warranted.

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    Flavio Lozano-Isla, Elizabeth Heros-Aguilar, Andres Casas-Diaz
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Impact of a narrative medicine program on reflective capacity and empathy of medical students in Iran  
Saeideh Daryazadeh, Payman Adibi, Nikoo Yamani, Roya Mollabashi
J Educ Eval Health Prof. 2020;17:3.   Published online January 27, 2020
DOI: https://doi.org/10.3352/jeehp.2020.17.3
  • 13,643 View
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AbstractAbstract PDFSupplementary Material
Purpose
Narrative medicine consists of the expression of medical experiences and the reflection on narratives to foster empathic communication with patients. Reflecting on narratives increases self-awareness and recognition of the feelings of the narrator or the story’s main character, which in turn affects the audience. This study was conducted to examine the impact of a narrative medicine program on the reflective capacity and empathy of medical students.
Methods
A quasi-experimental study was performed during the 2018–2019 academic year at Isfahan University of Medical Sciences in Iran involving 135 medical interns in 2 groups (control [n=66] and experimental [n=69]). Interns in the experimental group took part in seven 2-hour reflective practice sessions, while those in the control group underwent no educational intervention. Pre-test and post-test assessments were conducted for both groups using 2 valid and reliable tools for the assessment of reflective capacity and empathy. Mean reflection and empathy scores were compared within groups (between pre- and post-test values) and between groups (using the paired-t test and the t-test; P≤0.05).
Results
The mean reflection and empathy scores of the experimental group significantly increased from pre-test to post-test, but those of the control group did not. Moreover, the mean post-test scores were significantly different between the 2 groups (P<0.001).
Conclusion
Narrative medicine is an effective teaching method that can improve reflective capacity and empathy, thereby ultimately promoting professionalism as a core competency in medicine. Consideration of learning conditions and interdisciplinary teaching are necessary for implementing a narrative medicine program.

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Development of a checklist to validate the framework of a narrative medicine program based on Gagne’s instructional design model in Iran through consensus of a multidisciplinary expert panel  
Saeideh Daryazadeh, Nikoo Yamani, Payman Adibi
J Educ Eval Health Prof. 2019;16:34.   Published online October 31, 2019
DOI: https://doi.org/10.3352/jeehp.2019.16.34
  • 11,981 View
  • 189 Download
  • 1 Web of Science
  • 2 Crossref
AbstractAbstract PDFSupplementary Material
Purpose
Narrative medicine is a patient-centered approach focusing on the development of narrative skills and self-awareness that incorporates “attending, representing, and affiliating” in clinical encounters. Acquiring narrative competency promotes clinical performance, and narratives can be used for teaching professionalism, empathy, multicultural education, and professional development. This study was conducted to develop a checklist to validate the framework of a narrative medicine program through consensus of a panel.
Methods
This expert panel study was conducted from 2018 to 2019 at Isfahan University of Medical Sciences, Iran. It included 2 phases: developing a framework in 2 steps and forming an expert panel to validate the framework in 3 rounds. We adapted a 3-stage narrative medicine model with 9 training activities from Gagne’s theory, developed a framework, and then produced a checklist to validate the framework in a multidisciplinary expert panel that consisted of 7 experts. The RAND/UCLA appropriateness method was used to assess the experts’ agreement. The first-round opinions were received by email. Consensus was achieved in the second and third rounds through face-to-face meetings to facilitate interactions and discussion among the experts.
Results
Sixteen valid indicators were approved and 100% agreement was obtained among experts (with median values in the range of 7–9 out of a maximum of 9, with no disagreement), and the framework was validated by the expert panel.
Conclusion
The 16 checklist indicators can be used to evaluate narrative medicine programs as a simple and practical guide to improve teaching effectiveness and promote life-long learning.

Citations

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  • Challenges of Implementing the First Narrative Medicine Course for Teaching Professionalism in Iran: A Qualitative Content Analysis
    Saeideh Daryazadeh, Payman Adibi, Nikoo Yamani
    Educational Research in Medical Sciences.2022;[Epub]     CrossRef
  • Impact of a narrative medicine program on reflective capacity and empathy of medical students in Iran
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    Journal of Educational Evaluation for Health Professions.2020; 17: 3.     CrossRef
An innovative resident-driven mortality case review curriculum to teach and drive system-based practice improvements in the United States  
Nila S. Radhakrishnan, Margaret C. Lo, Rohit Bishnoi, Subhankar Samal, Robert Leverence, Eric Rosenberg, Zareen Zaidi
J Educ Eval Health Prof. 2018;15:31.   Published online December 26, 2018
DOI: https://doi.org/10.3352/jeehp.2018.15.31
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AbstractAbstract PDFSupplementary Material
Purpose
Traditionally, the morbidity and mortality conference (M&MC) is a forum where possible medical errors are discussed. Although M&MCs can facilitate identification of opportunities for systemwide improvements, few studies have described their use for this purpose, particularly in residency training programs. This paper describes the use of M&MC case review as a quality improvement activity that teaches system-based practice and can engage residents in improving systems of care.
Methods
Internal medicine residents at a tertiary care academic medical center reviewed 347 consecutive mortalities from March 2014 to September 2017. The residents used case review worksheets to categorize and track causes of mortality, and then debriefed with a faculty member. Selected cases were then presented at a larger interdepartmental meeting and action items were implemented. Descriptive statistics and thematic analysis were used to analyze the results.
Results
The residents identified a possible diagnostic mismatch at some point from admission to death in 54.5% of cases (n= 189) and a possible need for improved management in 48.0% of cases. Three possible management failure themes were identified, including failure to plan, failure to communicate, and failure to rescue, which accounted for 21.9%, 10.7 %, and 10.1% of cases, respectively. Following these reviews, quality improvement initiatives proposed by residents led to system-based changes.
Conclusion
A resident-driven mortality review curriculum can lead to improvements in systems of care. This novel type of curriculum can be used to teach system-based practice. The recruitment of teaching faculty with expertise in quality improvement and mortality case analyses is essential for such a project.

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    Moritz Sebastian Schönfeld, Martin Härter, Ann Sophie Schröder, Katrin Kokartis, Hans-Jürgen Bartz, Levente Kriston
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Learning through multiple lenses: analysis of self, peer, nearpeer, and faculty assessments of a clinical history-taking task in Australia  
Kylie Fitzgerald, Brett Vaughan
J Educ Eval Health Prof. 2018;15:22.   Published online September 18, 2018
DOI: https://doi.org/10.3352/jeehp.2018.15.22
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AbstractAbstract PDFSupplementary Material
Purpose
Peer assessment provides a framework for developing expected skills and receiving feedback appropriate to the learner’s level. Near-peer (NP) assessment may elevate expectations and motivate learning. Feedback from peers and NPs may be a sustainable way to enhance student assessment feedback. This study analysed relationships among self, peer, NP, and faculty marking of an assessment and students’ attitudes towards marking by those various groups.
Methods
A cross-sectional study design was used. Year 2 osteopathy students (n= 86) were invited to perform self and peer assessments of a clinical history-taking and communication skills assessment. NPs and faculty also marked the assessment. Year 2 students also completed a questionnaire on their attitudes to peer/NP marking. Descriptive statistics and the Spearman rho coefficient were used to evaluate relationships across marker groups.
Results
Year 2 students (n= 9), NPs (n= 3), and faculty (n= 5) were recruited. Correlations between self and peer (r= 0.38) and self and faculty (r= 0.43) marks were moderate. A weak correlation was observed between self and NP marks (r= 0.25). Perceptions of peer and NP marking varied, with over half of the cohort suggesting that peer or NP assessments should not contribute to their grade.
Conclusion
Framing peer and NP assessment as another feedback source may offer a sustainable method for enhancing feedback without overloading faculty resources. Multiple sources of feedback may assist in developing assessment literacy and calibrating students’ self-assessment capability. The small number of students recruited suggests some acceptability of peer and NP assessment; however, further work is required to increase its acceptability.

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Efficacy of an asynchronous electronic curriculum in emergency medicine education in the United States  
Alisa Wray, Kathryn Bennett, Megan Boysen-Osborn, Warren Wiechmann, Shannon Toohey
J Educ Eval Health Prof. 2017;14:29.   Published online December 11, 2017
DOI: https://doi.org/10.3352/jeehp.2017.14.29
  • 34,926 View
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AbstractAbstract PDFSupplementary Material
Purpose
The aim of this study was to measure the effect of an iPad-based asynchronous curriculum on emergency medicine resident performance on the in-training exam (ITE). We hypothesized that the implementation of an asynchronous curriculum (replacing 1 hour of weekly didactic time) would result in non-inferior ITE scores compared to the historical scores of residents who had participated in the traditional 5-hour weekly didactic curriculum.
Methods
The study was a retrospective, non-inferiority study. conducted at the University of California, Irvine Emergency Medicine Residency Program. We compared ITE scores from 2012 and 2013, when there were 5 weekly hours of didactic content, with scores from 2014 and 2015, when 1 hour of conference was replaced with asynchro-nous content. Examination results were compared using a non-inferiority data analysis with a 10% margin of difference.
Results
Using a non-inferiority test with a 95% confidence interval, there was no difference between the 2 groups (before and after implementation of asynchronous learning), as the confidence interval for the change of the ITE was −3.5 to 2.3 points, whereas the 10% non-inferiority margin was 7.8 points.
Conclusion
Replacing 1 hour of didactic conference with asynchronous learning showed no negative impact on resident ITE scores.

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Research Articles
Impact of a novel, resource appropriate resuscitation curriculum on Nicaraguan resident physician’s management of cardiac arrest  
Breena R. Taira, Aristides Orue, Edward Stapleton, Luis Lovato, Sitaram Vangala, Lucia Solorzano Tinoco, Orlando Morales
J Educ Eval Health Prof. 2016;13:25.   Published online June 9, 2016
DOI: https://doi.org/10.3352/jeehp.2016.13.25
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AbstractAbstract PDF
Purpose
Project Strengthening Emergency Medicine, Investing in Learners in Latin America (SEMILLA) created a novel, language and resource appropriate course for the resuscitation of cardiac arrest for Nicaraguan resident physicians. We hypothesized that participation in the Project SEMILLA resuscitation program would significantly improve the physician’s management of simulated code scenarios. Methods: Thirteen Nicaraguan resident physicians were evaluated while managing simulated cardiac arrest scenarios before, immediately, and at 6 months after participating in the Project SEMILLA resuscitation program. This project was completed in 2014 in Leon, Nicaragua. The Cardiac Arrest Simulation Test (CASTest), a validated scoring system, was used to evaluate performance on a standardized simulated cardiac arrest scenario. Mixed effect logistic regression models were constructed to assess outcomes. Results: On the pre-course simulation exam, only 7.7% of subjects passed the test. Immediately post-course, the subjects achieved a 30.8% pass rate and at 6 months after the course, the pass rate was 46.2%. Compared with pre-test scores, the odds of passing the CASTest at 6 months after the course were 21.7 times higher (95% CI 4.2 to 112.8, P<0.001). Statistically significant improvement was also seen on the number of critical items completed (OR=3.75, 95% CI 2.71-5.19), total items completed (OR=4.55, 95% CI 3.4-6.11), and number of “excellent” scores on a Likert scale (OR=2.66, 95% CI 1.85-3.81). Conclusions: Nicaraguan resident physicians demonstrate improved ability to manage simulated cardiac arrest scenarios after participation in the Project SEMILLA resuscitation course and retain these skills.

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Randomized study of effectiveness of computerized ultrasound simulators for an introductory course for residents in Brazil  
Jack Philip Silva, Trevor Plescia, Nathan Molina, Ana Claudia de Oliveira Tonelli, Mark Langdorf, John Christian Fox
J Educ Eval Health Prof. 2016;13:16.   Published online April 4, 2016
DOI: https://doi.org/10.3352/jeehp.2016.13.16
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AbstractAbstract PDF
Purpose
This study aimed to assess the impact of ultrasound simulation (SonoSim) on educational outcomes of an introductory point-of-care ultrasound course compared to hands-on training with live models alone. Methods: Fifty-three internal medicine residents without ultrasound experience were randomly assigned to control or experimental groups. They participated in an introductory point-of-care ultrasound course covering eight topics in eight sessions from June 23, 2014 until July 18, 2014. Both participated in lecture and hands-on training, but experimental group received an hour of computerized simulator training instead of a second hour of hands-on training. We assessed clinical knowledge and image acquisition with written multiple-choice and practical exams, respectively. Of the 53 enrolled, 40 participants (75.5%) completed the course and all testing. Results: For the 30-item written exam, mean score of the experimental group was 23.1±3.4 (n=21) vs. 21.8±4.8 (n=19), (P>0 .05). For the practical exam, mean score for both groups was 8.7 out of 16 (P>0 .05). Conclusion: The substitution of eight hours of ultrasound simulation training for live model scanning in a 24 hour training course did not enhance performance on written and image acquisition tests in an introductory ultrasound course for residents. This result suggests that ultrasound simulation technology used as a substitute for live model training on an hour-for-hour basis, did not improve learning outcomes. Further investigation into simulation as a total replacement for live model training will provide a clearer picture of the efficacy of ultrasound simulators in medical education.

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Psychometric properties of a novel knowledge assessment tool of mechanical ventilation for emergency medicine residents in the northeastern United States  
Jeremy B. Richards, Tania D. Strout, Todd A. Seigel, Susan R. Wilcox
J Educ Eval Health Prof. 2016;13:10.   Published online February 16, 2016
DOI: https://doi.org/10.3352/jeehp.2016.13.10
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AbstractAbstract PDF
Purpose
Prior descriptions of the psychometric properties of validated knowledge assessment tools designed to determine Emergency medicine (EM) residents understanding of physiologic and clinical concepts related to mechanical ventilation are lacking. In this setting, we have performed this study to describe the psychometric and performance properties of a novel knowledge assessment tool that measures EM residents’ knowledge of topics in mechanical ventilation.
Methods
Results from a multicenter, prospective, survey study involving 219 EM residents from 8 academic hospitals in northeastern United States were analyzed to quantify reliability, item difficulty, and item discrimination of each of the 9 questions included in the knowledge assessment tool for 3 weeks, beginning in January 2013.
Results
The response rate for residents completing the knowledge assessment tool was 68.6% (214 out of 312 EM residents). Reliability was assessed by both Cronbach’s alpha coefficient (0.6293) and the Spearman-Brown coefficient (0.6437). Item difficulty ranged from 0.39 to 0.96, with a mean item difficulty of 0.75 for all 9 questions. Uncorrected item discrimination values ranged from 0.111 to 0.556. Corrected item-total correlations were determined by removing the question being assessed from analysis, resulting in a range of item discrimination from 0.139 to 0.498.
Conclusion
Reliability, item difficulty and item discrimination were within satisfactory ranges in this study, demonstrating acceptable psychometric properties of this knowledge assessment tool. This assessment indicates that this knowledge assessment tool is sufficiently rigorous for use in future research studies or for assessment of EM residents for evaluative purposes.

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Emergency medicine and internal medicine trainees’ smartphone use in clinical settings in the United States  
Sonja E. Raaum, Christian Arbelaez, Carlos Eduardo Vallejo, Andres M. Patino, Jorie M. Colbert-Getz, Caroline K. Milne
J Educ Eval Health Prof. 2015;12:48.   Published online October 29, 2015
DOI: https://doi.org/10.3352/jeehp.2015.12.48
  • 30,083 View
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AbstractAbstract PDF
Purpose
Smartphone technology offers a multitude of applications (apps) that provide a wide range of functions for healthcare professionals. Medical trainees are early adopters of this technology, but how they use smartphones in clinical care remains unclear. Our objective was to further characterize smartphone use by medical trainees at two United States academic institutions, as well as their prior training in the clinical use of smartphones. Methods: In 2014, we surveyed 347 internal medicine and emergency medicine resident physicians at the University of Utah and Brigham and Women’s Hospital about their smartphone use and prior training experiences. Scores (0%–100%) were calculated to assess the frequency of their use of general features (email, text) and patient-specific apps, and the results were compared according to resident level and program using the Mann-Whitney U-test. Results: A total of 184 residents responded (response rate, 53.0%). The average score for using general features, 14.4/20 (72.2%) was significantly higher than the average score for using patient-specific features and apps, 14.1/44 (33.0%, P<0.001). The average scores for the use of general features, were significantly higher for year 3–4 residents, 15.0/20 (75.1%) than year 1–2 residents, 14.1/20 (70.5%, P=0.035), and for internal medicine residents, 14.9/20 (74.6%) in comparison to emergency medicine residents, 12.9/20 (64.3%, P= 0.001). The average score reflecting the use of patient-specific apps was significantly higher for year 3–4 residents, 16.1/44 (36.5%) than for year 1–2 residents, 13.7/44 (31.1%; P=0.044). Only 21.7% of respondents had received prior training in clinical smartphone use. Conclusion: Residents used smartphones for general features more frequently than for patient-specific features, but patient-specific use increased with training. Few residents have received prior training in the clinical use of smartphones.

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History Article
Medical licensing examination (uigwa) and the world of the physician officers (uigwan) in Korea’s Joseon Dynasty  
Nam Hee Lee
J Educ Eval Health Prof. 2015;12:16.   Published online May 7, 2015
DOI: https://doi.org/10.3352/jeehp.2015.12.16
  • 32,937 View
  • 182 Download
  • 2 Web of Science
  • 3 Crossref
AbstractAbstract PDF
Physicians for ordinary people in Joseon Dynasty (1392-1910) do not need to pass national medical licensing examination. They had done their job after enough period of apprenticeship. Only physician officers were licensed as technical civil servants. These physician officers were middle class, located socially between the nobility and the commoner. They had to pass a national licensing examination to be considered for high-ranking physician officers, that is, those at the rank above the 6th level out of a total of 9 ranks, where the first rank was highest. Royal physicians also had to pass this examination before accepting responsibility for the King’s healthcare. This article aims to describe the world of Physician officers during the Joseon Dynasty. Physician officers enjoyed considerable social status because they dealt with matters of life and death. Owing to the professional nature of their fields and a strong sense of group identity they came to compose a distinct social class. The physician officers’ world was marked by strong group allegiances based on shared professional knowledge; the use of marriage to gain and maintain social status; and the establishment of hereditary technical posts within the medical profession that were handed down from one generation to the next. The medical licensing examination persisted until 1894 when the civil service examination agency, of which it was part, was abolished. Until that time, the testing agency, the number of candidates who were accepted, two-step test procedures, and the method of test item selection were maintained and enforced. These aspects of the test could be considered characteristic of the medical licensing examination.

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    Murat KAÇER
    Mehmet Akif Ersoy Üniversitesi Sosyal Bilimler Enstitüsü Dergisi.2018; 10(26): 754.     CrossRef
Brief Report
Continuing medical education as a national strategy to improve access to primary care in Saudi Arabia  
Sami Ayed Alshammary, Savithiri Ratnapalan, Zekeriya Akturk
J Educ Eval Health Prof. 2013;10:7.   Published online August 31, 2013
DOI: https://doi.org/10.3352/jeehp.2013.10.7
  • 32,837 View
  • 178 Download
  • 1 Crossref
AbstractAbstract PDF
The purpose of this study was to describe the development, implementation, and evaluation of an educational program in family medicine for general practitioners in Saudi Arabia from 2009 to 2011. A continuing medical education program called Family Medicine Education (FAME) was developed with 7 modules each consisting of 12-14 hours of teaching to be delivered in 3 day blocks, over 45 days. Twenty percent (2,761) of all general practitioners participated in the FAME program. Initial assessment of the program showed significant improvement of knowledge from scores of 49% on a pre-test to 89% on post-tests. FAME program in Saudi Arabia facilitated primary care physicians’ knowledge.

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    Safar Abadi Alsaleem, Najwa Mohammed Almoalwi, Aesha Farheen Siddiqui, Mohammed Abadi Alsaleem, Awad S. Alsamghan, Nabil J. Awadalla, Ahmed A. Mahfouz
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Research Article
Strengthening the admissions process in health care professional education: focus on a premier Pacific Island medical college
Christian Chinyere Ezeala, Mercy Okwudili Ezeala, Niraj Swami
J Educ Eval Health Prof. 2012;9:11.   Published online November 30, 2012
DOI: https://doi.org/10.3352/jeehp.2012.9.11
  • 33,511 View
  • 164 Download
  • 3 Crossref
AbstractAbstract PDF
Relying solely on measures of intellectual aptitude and academic performance in university admissions can be disadvantageous to underprivileged students. The Fiji School of Medicine primarily uses such measures to evaluate and select student applicants, and the introduction of supplementary assessments could provide better access for students from disadvantaged backgrounds. This study examined the need for supplementary assessments in the admission process, types of additional assessments needed, and stakeholders??views on a multi-entry multi-exit strategy currently in use at the Fiji School of Medicine. A survey of the key stakeholders was conducted in February and March 2012 using closed and open ended questionnaire. One hundred and twenty-two validated questionnaires were self-administered by key stakeholders from the College of Medicine, Nursing and Health Sciences (CMNHS) and Fiji Ministries of Education and Health, with a response rate of 61%. Returned questionnaires were analysed quantitatively and qualitatively. Sixty-five percent of respondents supported the introduction of supplementary assessments, 49% favoured admissions test, and 16% preferred assessing non-academic factors. Many respondents supported the School?占퐏 multi-entry multi-exit strategy as a ?占퐂ood policy??that provided ?占퐀lexibility??and opportunity for students, but should be better regulated. These findings demonstrate the need for supplementary assessments in the selection process and for continued support for the use of multi-entry multi-exit strategy at the school.

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Brief Report
Evaluation of the Learning Environment for Diploma in Family Medicine with the Dundee Ready Education Environment (DREEM) Inventory
A. Sattar Khan, Zekeriya Akturk, Tarek Al-Megbil
J Educ Eval Health Prof. 2010;7:2.   Published online November 29, 2010
DOI: https://doi.org/10.3352/jeehp.2010.7.2
  • 37,849 View
  • 190 Download
  • 14 Crossref
PDF

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JEEHP : Journal of Educational Evaluation for Health Professions
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