Journal of Educational Evaluation for Health Professions

Research articles

Impact of a change from A–F grading to honors/pass/fail grading on academic performance at Yonsei University College of Medicine in Korea: a cross-sectional serial mediation analysis: Min-Kyeong Kim, Hae Won Kim; J Educ Eval Health Prof. 2024;21:20. Published online August 16, 2024; DOI: https://doi.org/10.3352/jeehp.2024.21.20; Correction in: J Educ Eval Health Prof 2024;21(0):35

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Purpose
This study aimed to explore how the grading system affected medical students’ academic performance based on their perceptions of the learning environment and intrinsic motivation in the context of changing from norm-referenced A–F grading to criterion-referenced honors/pass/fail grading.
Methods
The study involved 238 second-year medical students from 2014 (n=127, A–F grading) and 2015 (n=111, honors/pass/fail grading) at Yonsei University College of Medicine in Korea. Scores on the Dundee Ready Education Environment Measure, the Academic Motivation Scale, and the Basic Medical Science Examination were used to measure overall learning environment perceptions, intrinsic motivation, and academic performance, respectively. Serial mediation analysis was conducted to examine the pathways between the grading system and academic performance, focusing on the mediating roles of student perceptions and intrinsic motivation.
Results
The honors/pass/fail grading class students reported more positive perceptions of the learning environment, higher intrinsic motivation, and better academic performance than the A–F grading class students. Mediation analysis demonstrated a serial mediation effect between the grading system and academic performance through learning environment perceptions and intrinsic motivation. Student perceptions and intrinsic motivation did not independently mediate the relationship between the grading system and performance.
Conclusion
Reducing the number of grades and eliminating rank-based grading might have created an affirming learning environment that fulfills basic psychological needs and reinforces the intrinsic motivation linked to academic performance. The cumulative effect of these 2 mediators suggests that a comprehensive approach should be used to understand student performance.

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Erratum: Impact of a change from A–F grading to honors/pass/fail grading on academic performance at Yonsei University College of Medicine in Korea: a cross-sectional serial mediation analysis

Journal of Educational Evaluation for Health Professions.2024; 21: 35. CrossRef

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.

Brief report

Self-directed learning quotient and common learning types of pre-medical students in Korea by the Multi-Dimensional Learning Strategy Test 2nd edition: a descriptive study: Sun Kim, A Ra Cho, Chul Woon Chung; J Educ Eval Health Prof. 2022;19:32. Published online November 28, 2022; DOI: https://doi.org/10.3352/jeehp.2022.19.32

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Abstract PDF Supplementary Material: This study aimed to find the self-directed learning quotient and common learning types of pre-medical students through the confirmation of 4 characteristics of learning strategies, including personality, motivation, emotion, and behavior. The response data were collected from 277 out of 294 target first-year pre-medical students from 2019 to 2021, using the Multi-Dimensional Learning Strategy Test 2nd edition. The most common learning type was a self-directed type (44.0%), stagnant type (33.9%), latent type (14.4%), and conscientiousness type (7.6%). The self-directed learning index was high (29.2%), moderate (24.6%), somewhat high (21.7%), somewhat low (14.4%), and low (10.1%). This study confirmed that many students lacked self-directed learning capabilities for learning strategies. In addition, it was found that the difficulties experienced by each student were different, and the variables resulting in difficulties were also diverse. It may provide insights into how to develop programs that can help students increase their self-directed learning capability.

Research articles

Self-control as an important factor affecting the online learning readiness of Vietnamese medical and health students during the COVID-19 pandemic: a network analysis: Minh Tu Nguyen, Binh Thang Tran, Thanh Gia Nguyen, Minh Tri Phan, Thi Thu Tham Luong, Dinh Duong Le; J Educ Eval Health Prof. 2022;19:22. Published online August 25, 2022; DOI: https://doi.org/10.3352/jeehp.2022.19.22

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Abstract PDF Supplementary Material

Purpose
The current study aimed to use network analysis to investigate medical and health students’ readiness for online learning during the coronavirus disease 2019 (COVID-19) pandemic at the University of Medicine and Pharmacy, Hue University.
Methods
A questionnaire survey on the students’ readiness for online learning was performed using a Google Form from May 13 to June 22, 2021. In total, 1,377 completed responses were eligible for analysis out of 1,411 participants. The network structure was estimated for readiness scales with 6 factors: computer skills, internet skills, online communication, motivation, self-control, and self-learning. Data were fitted using a Gaussian graphical model with the extended Bayesian information criterion.
Results
In 1,377 students, a network structure was identified with 6 nodes and no isolated nodes. The top 3 partial correlations were similar in networks for the overall sample and subgroups of gender and grade levels. The self-control node was the strongest for the connection to others, with the highest nodal strength. The change of nodal strength was greatest in online communication for both gender and grade levels. The correlation stability coefficient for nodal strength was achieved for all networks.
Conclusion
These findings indicated that self-control was the most important factor in students’ readiness network structures for online learning. Therefore, self-control needs to be encouraged during online learning to improve the effectiveness of achieving online learning outcomes for students.

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Nodewise Parameter Aggregation for Psychometric Networks
K. B. S. Huth, B. DeLong, L. Waldorp, M. Marsman, M. Rhemtulla
Multivariate Behavioral Research.2025; : 1. CrossRef
Distance Education through the Perspective of Students of Anesthetic Technician, Emergency Medical Technician, and Medical Imaging Technician Programs
Hatice Kalender, Nur Şişman Kitapçı, Burcu Aksoy, Zehra Özge Çandereli, Şükrü Can Akmansoy, Okan Cem Kitapçı, Ümit Karaçaylı, Gonca Mumcu
International Journal of Health Management and Tourism.2024;[Epub] CrossRef

Increased competency of registered dietitian nutritionists in physical examination skills after simulation-based education in the United States: Elizabeth MacQuillan, Jennifer Ford, Kristin Baird; J Educ Eval Health Prof. 2020;17:40. Published online December 14, 2020; DOI: https://doi.org/10.3352/jeehp.2020.17.40

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Purpose
This study aimed to translate simulation-based dietitian nutritionist education to clinical competency attainment in a group of practicing registered dietitian nutritionists (RDNs). Using a standardized instrument to measure performance on a newly-required clinical skill, the nutrition-focused physical exam (NFPE), competence was measured both before and after a simulation-based education (SBE) session.
Methods
Eighteen practicing RDNs were recruited by their employer, Spectrum Health. Following a pre-briefing session, participants completed an initial 10-minute encounter, performing NFPE on a standardized patient (SP). Next, participants completed a 90-minute SBE training session on skills within the NFPE, including hands-on practice and role play, followed by a post-training SP encounter. Video recordings of the SP encounters were scored to assess competence in 7 skill areas within the NFPE. Scores were analyzed for participants’ initial competence and change in competence.
Results
The proportions of participants with initial competence ranged from 0% to 44% across the 7 skill areas assessed. The only competency where participants initially scored in the “meets expectations” range was “approach to the patient.” When raw competence scores were assessed for changes from pre- to post-SBE training, the paired t-test indicated significant increases in all 7 competency areas following the simulation-based training (P<0.001).
Conclusion
This study showed the effectiveness of a SBE training program for increasing competence scores of practicing RDNs on a defined clinical skill.

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Gina Choi, Jihane N. Benhammou, Jung J. Yum, Elena G. Saab, Ankur P. Patel, Andrew J. Baird, Stephanie Aguirre, Douglas G. Farmer, Sammy Saab
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Motivational profiles and their relationships with basic psychological needs, academic performance, study strategies, self-esteem, and vitality in dental students in Chile: Cesar A. Orsini, Vivian I. Binnie, Jorge A. Tricio; J Educ Eval Health Prof. 2018;15:11. Published online April 19, 2018; DOI: https://doi.org/10.3352/jeehp.2018.15.11

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Abstract PDF Supplementary Material

Purpose
To determine dental students’ motivational profiles through a person-centred approach and to analyse the associations with the satisfaction of their basic psychological needs, study strategies, academic performance, self-esteem, and vitality.
Methods
A total of 924 students from the University of San Sebastian (Chile) participated in this cross-sectional cor¬relational study in spring 2016. Data were collected through 5 self-reported instruments, in addition to students’ academic performance. The Cronbach alpha, descriptive statistics, and correla¬tion scores were computed. A k-means cluster analysis with intrinsic and controlled motivation was conducted to identify different mo-tivational profiles. Subsequently, multivariate analysis of covariance controlling for the effects of gender and year of study was carried out to assess differences among the retained motivational profiles and learning variables.
Results
All instruments showed acceptable Cronbach alpha scores. A 4-cluster solution was retained for the motivational profile over a 3- or 5-cluster solution. Students’ motiva-tional profiles were characterized by different degrees of intrinsic and controlled motivation. The high intrinsic motivation groups showed higher perceptions of their basic psychological, a greater propensity for a deep rather than surface study strategy, better academic performance, and higher scores for self-esteem and vitality than the low intrinsic motivation groups, regardless of the degree of controlled motivation.
Conclusion
Students with a high intrinsic motivation profile, regardless of their controlled motivation scores, reported better learning characteristics. Therefore, special attention should be paid to students’ motivational profiles, as the quality of motivation might serve as a basis for interventions to support their academic success and well-being.

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Review article

The impacts of computer adaptive testing from a variety of perspectives: Tetsuo Kimura; J Educ Eval Health Prof. 2017;14:12. Published online May 29, 2017; DOI: https://doi.org/10.3352/jeehp.2017.14.12

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Abstract PDF

Computer adaptive testing (CAT) is a kind of tailored testing, in that it is a form of computer-based testing that is adaptive to each test-taker’s ability level. In this review, the impacts of CAT are discussed from different perspectives in order to illustrate crucial points to keep in mind during the development and implementation of CAT. Test developers and psychometricians often emphasize the efficiency and accuracy of CAT in comparison to traditional linear tests. However, many test-takers report feeling discouraged after taking CATs, and this feeling can reduce learning self-efficacy and motivation. A trade-off must be made between the psychological experiences of test-takers and measurement efficiency. From the perspective of educators and subject matter experts, nonstatistical specifications, such as content coverage, content balance, and form length are major concerns. Thus, accreditation bodies may be faced with a discrepancy between the perspectives of psychometricians and those of subject matter experts. In order to improve test-takers’ impressions of CAT, the author proposes increasing the target probability of answering correctly in the item selection algorithm even if doing so consequently decreases measurement efficiency. Two different methods, CAT with a shadow test approach and computerized multistage testing, have been developed in order to ensure the satisfaction of subject matter experts. In the shadow test approach, a full-length test is assembled that meets the constraints and provides maximum information at the current ability estimate, while computerized multistage testing gives subject matter experts an opportunity to review all test forms prior to administration.

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Review Article

Determinants and outcomes of motivation in health professions education: a systematic review based on self-determination theory: Cesar Orsini, Vivian I. Binnie, Sarah L. Wilson; J Educ Eval Health Prof. 2016;13:19. Published online May 2, 2016; DOI: https://doi.org/10.3352/jeehp.2016.13.19

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Abstract PDF

Purpose
This study aimed at conducting a systematic review in health professions education of determinants, mediators and outcomes of students’ motivation to engage in academic activities based on the self-determination theory’s perspective. Methods: A search was conducted across databases (MEDLINE, CINHAL, EMBASE, PsycINFO, and ERIC databases), hand-search of relevant journals, grey literature, and published research profile of key authors. Quantitative and qualitative studies were included if they reported research in health professions education focused on determinants, mediators, and/or outcomes of motivation from the self-determination and if meeting the quality criteria. Results: A total of 17 studies met the inclusion and quality criteria. Articles retrieved came from diverse locations and mainly from medical education and to a lesser extent from psychology and dental education. Intrapersonal (gender and personality traits) and interpersonal determinants (academic conditions and lifestyle, qualitative method of selection, feedback, and an autonomy supportive learning climate) have been reported to have a positive influence on students’ motivation to engage in academic activities. No studies were found that tested mediation effects between determinants and students’ motivation. In turn, students’ self-determined motivation has been found to be positively associated with different cognitive, affective, and behavioural outcomes. Conclusion: This study has found that generally, motivation could be enhanced by changes in the educational environment and by an early detection of students’ characteristics. Doing so may support future health practitioners’ self-determined motivation and positively influence how they process information and their emotions and how they approach their learning activities.

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Brief Reports

How many schools adopt interviews during the student admission process across the health professions in the United States of America?: Greer Glazer, Laura F. Startsman, Karen Bankston, Julia Michaels, Jennifer C. Danek, Malika Fair; J Educ Eval Health Prof. 2016;13:12. Published online February 27, 2016; DOI: https://doi.org/10.3352/jeehp.2016.13.12

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Abstract PDF

Health profession schools use interviews during the admissions process to identify certain non-cognitive skills that are needed for success in diverse, inter-professional settings. This study aimed to assess the use of interviews during the student admissions process across health disciplines at schools in the United States of America in 2014. The type and frequency of non-cognitive skills assessed were also evaluated. Descriptive methods were used to analyze a sample of interview rubrics collected as part of a national survey on admissions in the health professions, which surveyed 228 schools of medicine, dentistry, pharmacy, nursing, and public health. Of the 228 schools, 130 used interviews. The most desirable non-cognitive skills from 34 schools were identified as follows: communication skills (30), motivation (22), readiness for the profession (17), service (12), and problem-solving (12). Ten schools reported using the multiple mini-interview format, which may indicate potential for expanding this practice. Disparities in the use of interviewing across health professions should be verified to help schools adopt interviews during student admissions processes.

Citations

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Analysis of the study skills of undergraduate pharmacy students of the University of Zambia School of Medicine: Christian Chinyere Ezeala, Nalucha Siyanga; J Educ Eval Health Prof. 2015;12:46. Published online September 25, 2015; DOI: https://doi.org/10.3352/jeehp.2015.12.46

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Abstract PDF

It aimed to compare the study skills of two groups of undergraduate pharmacy students in the School of Medicine, University of Zambia using the Study Skills Assessment Questionnaire (SSAQ), with the goal of analysing students’ study skills and identifying factors that affect study skills. A questionnaire was distributed to 67 participants from both programs using stratified random sampling. Completed questionnaires were rated according to participants study skill. The total scores and scores within subscales were analysed and compared quantitatively. Questionnaires were distributed to 37 students in the regular program, and to 30 students in the parallel program. The response rate was 100%. Students had moderate to good study skills: 22 respondents (32.8%) showed good study skills, while 45 respondents (67.2%) were found to have moderate study skills. Students in the parallel program demonstrated significantly better study skills (mean SSAQ score, 185.4±14.5), particularly in time management and writing, than the students in the regular program (mean SSAQ score 175±25.4; P<0.05). No significant differences were found according to age, gender, residential or marital status, or level of study. The students in the parallel program had better time management and writing skills, probably due to their prior work experience. The more intensive training to students in regular program is needed in improving time management and writing skills.

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Assessing Competences of Geography Students Acquired through the Competence-based Teaching and Learning Approach in Rwandan Secondary Schools
Dan Imaniriho, Vincent Manirakiza, Delphine Mukingambeho, Mahsen Nyirishema, Innocent Muhire, Jean Leonard Buhigiro
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Factors that influence the choice to work in rural township health centers among 4,669 clinical medical students from five medical universities in Guangxi, China: Yunbo Qing, Guijie Hu, Qingyun Chen, Hailun Peng, Kailan Li, Jinling Wei, Yanhua Yi; J Educ Eval Health Prof. 2015;12:40. Published online July 10, 2015; DOI: https://doi.org/10.3352/jeehp.2015.12.40

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Abstract PDF

Purpose
To produce competent undergraduate-level medical doctors for rural township health centers (THCs), the Chinese government mandated that medical colleges in Central and Western China recruit rural-oriented, tuition-waived medical students (RTMSs) starting in 2010. This study aimed to identify and assess factors that influence the choice to work in rural township health centers among both RTMSs and other students from five medical universities in Guangxi, China. Methods: An internet-based self-administered questionnaire survey was conducted with medical students in Guangxi province. Multinomial logistic regression was used to identify factors related to the attitudes toward work in a rural township health center. Results: Among 4,669 medical students, 1,523 (33%) had a positive attitude and 2,574 (55%) had a neutral attitude toward working in THCs. Demographic characteristics, personal job concerns, and knowledge of THCs were associated with the choice of a career in THCs. The factors related to a positive attitude included the following: three-year program, a rural-oriented medical program, being male, an expectation of working in a county or township, a focus on medical career development, some perceived difficulty of getting a job, having family support, sufficient knowledge of THCs, optimism toward THC development, seeking lower working pressure, and a lower expected monthly salary. Conclusion: Male students in a three-year program or a rural-oriented tuition-waived medical education program were more likely to work in THCs. Selecting medical students through interviews to identify their family support and intentions to work in THCs would increase recruitment and retention. Establishing favorable policies and financial incentives to improve living conditions and the social status of rural physicians is necessary.

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Factors influencing reselection of village doctors in rural-oriented tuition-waived medical education program in Shanghai, China: a cross-sectional study
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Job satisfaction and turnover of the first group of rural-oriented tuition-waived medical students in Guangxi, China: a mixed-method study
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How can a postgraduate professional education and development course benefit general practitioners?: a qualitative study: Steven Agius, Rebecca Baron, Barry Lewis, Stephen Luckhurst, Mark Sloan, Thomas Ward; J Educ Eval Health Prof. 2015;12:31. Published online June 20, 2015; DOI: https://doi.org/10.3352/jeehp.2015.12.31

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Abstract PDF: Purpose
The rationale for ‘professional education and development’ (PED) courses is to support general practitioners, enabling them to access a range of theoretical and practical skills within a supportive schema. It aims to identify whether and how a regional PED course has had a beneficial impact upon participants. Methods: The study comprised a qualitative investigation of participants’ assessed coursework portfolios. The content of each portfolio gives individual accounts of the impact of the course on personal and practice development. Permission to access extant portfolios was obtained from 16 recent alumni of the course. The anonymous written material was analysed by the research team for recurring discourses and themes using a thematic framework analysis. Results: Seven major thematic categories were extrapolated from the data: leadership, resilience, quality improvement, change management, development of new services, educational expertise, and patient safety. In each category, we found evidence that the course enabled development of practitioners by enhancing knowledge and skills which had a positive impact upon their self-perceived effectiveness and motivation. Conclusion: Extended specialty training is on the horizon but such courses may still serve a valuable purpose for current trainees and the existing general practitioners workforce which will be responsible for leading the shift towards community-based service delivery.

The implementation of problem-based learning in collaborative groups in a chiropractic program in Malaysia: Ni Ni Win, Vishna Devi V Nadarajah, Daw Khin Win; J Educ Eval Health Prof. 2015;12:17. Published online May 8, 2015; DOI: https://doi.org/10.3352/jeehp.2015.12.17

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Abstract PDF

Purpose
Problem-based learning (PBL) is usually conducted in small-group learning sessions with approximately eight students per facilitator. In this study, we implemented a modified version of PBL involving collaborative groups in an undergraduate chiropractic program and assessed its pedagogical effectiveness. Methods: This study was conducted at the International Medical University, Kuala Lumpur, Malaysia, and involved the 2012 chiropractic student cohort. Six PBL cases were provided to chiropractic students, consisting of three PBL cases for which learning resources were provided and another three PBL cases for which learning resources were not provided. Group discussions were not continuously supervised, since only one facilitator was present. The students’ perceptions of PBL in collaborative groups were assessed with a questionnaire that was divided into three domains: motivation, cognitive skills, and perceived pressure to work. Results: Thirty of the 31 students (97%) participated in the study. PBL in collaborative groups was significantly associated with positive responses regarding students’ motivation, cognitive skills, and perceived pressure to work (P<0.05). The students felt that PBL with learning resources increased motivation and cognitive skills (P<0.001). Conclusion: The new PBL implementation described in this study does not require additional instructors or any additional funding. When implemented in a classroom setting, it has pedagogical benefits equivalent to those of small-group sessions. Our findings also suggest that students rely significantly on available learning resources.

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Collaborative method consisting lecture, problem-based learning and weblog for clinical courses of medical students in comparison with lecture method
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How to encourage intrinsic motivation in the clinical teaching environment?: a systematic review from the self-determination theory: Cesar Orsini, Phillip Evans, Oscar Jerez; J Educ Eval Health Prof. 2015;12:8. Published online April 8, 2015; DOI: https://doi.org/10.3352/jeehp.2015.12.8

53,823 View
599 Download
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Abstract PDF

Purpose
Internalization of students’ motivation towards an intrinsic form is associated with increased interest, commitment, learning, and satisfaction with education. Self-Determination theory postulates that intrinsic motivation and autonomous forms of self-regulation are the desired type of motivation; as they have been associated with deep learning, better performance and well-being. It claims three basic psychological needs have to be satisfied in order to achieve intrinsic motivation. These are the needs for autonomy, competence and relatedness. This study aims to provide a review on how these basic psychological needs are encouraged in undergraduate students so they can be transferred to the clinical teaching environment. Methods: Electronic searches were performed across four databases (Medline, Embase, PsycINFO, and ERIC), relevant journals, and retrieved bibliography of selected articles. In total, searches produced 4,869 references, from which 16 studies met the inclusion criteria. Results: Main themes were coded in three categories: The support of autonomy, competence and relatedness. The research-based evidence appears to be of reasonable quality, and indicates that teachers should work to satisfy students’ basic psychological needs to foster internalization of self-regulation. Our findings suggest that teachers should interact with students in a more ‘human centred’ teaching style, as these actions predict motivational internalization. Several themes emerged from different contexts and further investigation should expand them. Conclusion: This review identified actions that clinical teachers could implement in their daily work to support students’ self-determination. Autonomy supportive teaching in health professions educations would benefit students and may actually result in more effective health care delivery.

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Higher satisfaction with ethnographic edutainment using YouTube among medical students in Thailand: Thira Woratanarat; J Educ Eval Health Prof. 2014;11:13. Published online July 7, 2014; DOI: https://doi.org/10.3352/jeehp.2014.11.13

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Abstract PDF

Purpose
At present, transformative learning is one of the most important issues in medical education, since a conventional learning environment is prone to failure due to changing patterns among students. Ethnographic edutainment is a concept that consists of reward, competition, and motivation strategies that be used to effectively engage with learners. Methods: A total 321 first-year medical students took part in ethnographic edutainment sessions in 2011. We defined four preset learning objectives and assigned a term group project using clouding technologies. Participatory evaluation was conducted to assess the delivery of and attitudes towards this method. Results: Career lifestyles in the general population and expected real-life utilization of the final product were used as motivating factors, with competition and rewards provided through a short film contest. Nineteen out of twenty groups (95%) achieved all learning objectives. Females were more satisfied with this activity than males (P<0.001). We found statistically significant differences between lecture-based sessions and field visit sessions, as well as ethnographic edutainment activity sessions and other instructional approaches (P<0.01). The results were consistent in male and female groups. Conclusion: Ethnographic edutainment is well accepted, with higher satisfaction rates than other types of teaching. The concepts of health promotion and the social determinants of health can be learned through ethnographic edutainment activities, which might help train more humanized health professionals.

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