HyeRin Roh

The relationships between empathy, stress and social support among medical students

Objectives To examine the relationship between stress, social support, and empathy among medical students. Methods We evaluated the relationships between stress and empathy, and social support and empathy among medical students. The respondents completed a question-naire including demographic information, the Jefferson Scale of Empathy, the Perceived Stress Scale, and the Multidimensional Scale of Perceived Social Support. Corre-lation and linear regression analyses were conducted, along with sub-analyses according to gender, admission system, and study year. Results In total, 2,692 questionnaires were analysed. Empathy and social support positively correlated, and empathy and stress negatively correlated. Similar correla-tion patterns were detected in the sub-analyses; the correla-tion between empathy and stress among female students was negligible. In the regression model, stress and social support predicted empathy among all the samples. In the sub-analysis, stress was not a significant predictor among female and first-year students. Conclusions Stress and social support were significant predictors of empathy among all the students. Medical educators should provide means to foster resilience against stress or stress alleviation, and to ameliorate social support, so as to increase or maintain empathy in the long term. Furthermore, stress management should be emphasised, particularly among female and first-year students.

Empathy in Korean medical students: Findings from a nationwide survey

Abstract Background: Previous studies on empathy in Korean medical students were conducted on small populations or with different scales of measurement, resulting in low representativeness and generalisability of the findings. Aim: To evaluate empathy in Korean medical students throughout the country and to make suggestions to improve empathy. Methods: The Jefferson Scale of Empathy (JSE) (Korean) was used, and the impact of sex, age, the medical school admission system, and grade of the respondents was investigated. Results: We analyzed 5343 questionnaires and found a mean empathy score of 105.9 ± 12.8. Females and post-baccalaureate students had higher scores as compared with their counterparts. There was a significant difference between the admission systems after controlling for gender. Students from higher grade levels had lower scores than those from the lower grade levels. Conclusions: The JSE score of Korean medical students was lower than that of students in Western countries. The difference of gender and medical school admission system should be considered, and capability to apply empathy to clinical practice should be focused upon in medical training.

Depressive symptoms in medical students: prevalence and related factors.

PURPOSE This study was designed to estimate the prevalence of depression and the factors that influence it in Korean medical students. METHODS We evaluated depression in 122 first- and second-year medical students in December 2011 using the Korean Beck Depression Inventory (K-BDI). Sixteen potential factors were considered: gender, class year, grade point average, breakfast habits, residence type, leisure activity, sleep satisfaction, relationship status, a close friend or a significant other, finances, present health status, history of mood disorders, family history of mood disorders, religion, and self-esteem. RESULTS The average BDI score was 8.9. There were 80 (65.6%), 16 (13.1%), 15 (12.3%), and 11 (9.0%) students with minimal, mild, moderate, and severe depression, respectively. The group with depressive symptoms comprised males with a total BDI score > or =24 and females with total BDI > or =25 and constituted 9.0% of students. Students in the depressive symptom group had lower self-esteem and lower grade point averages and were more frequently ill, less likely to be in a relationship, and more likely to have a history of mood disorders (p<0.05 for all). In particular, low self-esteem score was an independent factor. CONCLUSION The BDI scores in our study were similar to those that have been reported in other countries but slightly higher than in other Korean medical and university students. Self-esteem, grade point average, health status, history of mood disorders, family history of mood disorders, and presence of a significant other correlated significantly with depression in medical students.

Development of Task-Based Learning Outcomes according to Clinical Presentations for Clinical Clerkships.

PURPOSE The aim of the study was to introduce our experience of establish task-based learning outcomes for core clinical clerkships. METHODS We first define our educational goal and objectives of the clinical clerkship curriculum according to knowledge, cognitive function and skill, and attitude. We selected clinical presentations and related diseases with expert panels and allocated them to core clinical departments. We classified doctors tasks into 6 categories: history taking, physical examination, diagnostic plan, therapeutic plan, acute and emergent management, and prevention and patient education. We described learning outcomes by task using behavioral terms. RESULTS We established goals and objectives for students to achieve clinical competency on a primary care level. We selected 75 clinical presentations and described 377 learning outcomes. CONCLUSION Our process can benefit medical schools that offer outcome-based medical education, especially for clinical clerkships. To drive effective clerkships, a supportive system including assessment and faculty development should be implemented.

Ubiquitous-based testing in medical education

them, breathless and unable to speak. No other medical personnel were present, and they alone could work out the diagnosis and treat the patient. The clues they had were four envelopes, which contained an ECG, a chest X-ray, blood and sputum cultures, and the results of an arterial blood gas. The students were given minimal background information: simple guides to interpreting the basics of each investigation; a brief medical glossary to explain terms such as acidosis, consolidation and tachycardia; a list of eleven possible diagnoses with expected corresponding findings in the clues; and the clues themselves. They were allowed to see each clue for up to five minutes, but could not see the same clue again once their time with it had elapsed. Following initial trepidation, they quickly got to work in groups of four. The underlying diagnosis was an infective exacerbation of COPD, with the clues corresponding to this (e.g. an ECG showing sinus tachycardia and a hyper-expanded chest X-ray). Satisfaction was audible as pennies dropped around the room, students spotting what they were looking for in each ‘‘clue’’. Three out of the four groups arrived at the correct diagnosis, and the final group came close, but wrongly identified the case as acute respiratory distress syndrome due to misinterpretation of the chest X-ray. Despite no medical background, the students were able to suggest oxygen, antibiotics and inhalers as the treatment they would want to provide. Diagnosing medical cases provides potent opportunities to raise scientific curiosity and develop problem-solving skills, even to those years away from considering starting medical school. I left the session impressed at the students’ abilities and reinvigorated in enthusiasm for teaching.

Development of guide to clinical performance and basic clinical skills for medical students

The aim of this report was to discuss the development and content of a guide on clinical performance and basic clinical skills for medical students. We published the first edition of this guide in 2010 and will publish the second edition in 2016. Initially, we took a survey on important clinical presentations and fundamental clinical and technical skills in 41 medical schools in Korea. Ultimately, we chose 80 core clinical presentations and 56 clinical skills. In the guide to basic clinical skills, we described the physical examination and technical skills according to the preprocedural preparation, procedure, and postprocedural process. In the guide on clinical performance, we reviewed patient encounters-from history taking and the physical examination to patient education. We included communication skills, principles of patient safety, and clinical reasoning schemes into the guides. In total, 43 academic faculty members helped develop the basic clinical skills guide, 75 participated in establishing the clinical performance guide, and 16 advisors from 14 medical specialty societies contributed to the guide. These guides can help medical students approach patients holistically and safely.

Development of a portfolio for competency-based assessment in a clinical clerkship curriculum

The purpose of this report was to describe our experience in planning and developing a portfolio for a clinical clerkship curriculum. We have developed a portfolio for assessing student competency since 2007. During an annual workshop on clinical clerkship curricula, clerkship directors from five Paik hospitals of Inje University met to improve the assessment of the portfolio. We generated templates for students to record their activities and reflection and receive feedback. We uploaded these templates to our schools website for students to download freely. Annually, we have held a faculty development seminar and a workshop for portfolio assessment and feedback. Also, we established an orientation program on how to construct a learning portfolio for students. Future actions include creating a ubiquitous portfolio system, extending the portfolio to the entire curriculum, setting up an advisor system, and managing the quality of the portfolio. This study could be helpful for medical schools that plan to improve their portfolio assessment with an outcome-based approach.

Medical students interact with multicultural patients to learn cultural diversity

Purpose The aim was to present our experiences implementing a cultural diversity (CD) education program. Methods The authors held a 4-hour CD class for third-year medical students. The aim of the class was to facilitate students to realize and reflect on the importance of CD on healthcare delivery in Korea. The class was comprised of an orientation about CD in Korea, physicians and multicultural guests sharing their experiences with students, small group discussion, and Q&A panel with multicultural guests. Students provided written feedback for program evaluation. Authors classified their comments qualitatively. Results Students mostly responded positively to the class with a significant focus on interacting with the multicultural guests. Students realized the significance of CD in healthcare and reflected deeply on their discussion with the multicultural patients. Students needed more time to interact with multicultural guests from a greater range of cultures represented in Korea. Most did not need English interpretation. Conclusion The aim of the class was achieved. Medical students’ interaction with multicultural patients may promote the students’ understanding and reflection about CD in health care.

Medical students’ clinical performance of dealing with patients in the context of domestic violence

Purpose The aim of this study was to inquire about the clinical performance and determine the performance pattern of medical students in standardized patient (SP) based examinations of domestic violence (DV). Methods The clinical performance sores in DV station with SP of third-year (n=111, in 2014) and 4th-year (n=143, in 2016) medical students of five universities in the Busan-Gyeongnam Clinical Skills Examination Consortium were subjected in this study. The scenarios and checklists of DV cases were developed by the case development committee of the consortium. The students’ performance was compared with other stations encountered in SP. The items of the checklists were categorized to determine the performance pattern of students investigating DV into six domains: disclosure strategy (D), DV related history taking (H), checking the perpetrator’s psychosocial state (P), checking the victim’s condition (V), negotiating and persuading the interviewee (N), and providing information about DV (I). Results Medical students showed poorer performance in DV stations than in the other stations with SP in the same examination. Most students did confirm the perpetrator and commented on confidentiality but ignored the perpetrator’s state and patient’s physical and psychological condition. The students performed well in the domains of D, H, and I but performed poorly in domains P, V, and N. Conclusion Medical students showed poor clinical performance in the DV station. They performed an ‘event oriented interview’ rather than ‘patient centered’ communication. An integrated educational program of DV should be set to improve students’ clinical performance.

Authenticity, acceptability, and feasibility of a hybrid gynecology station for the Papanicolaou test as part of a clinical skills examination in Korea

Purpose The objective of this study was to evaluate the authenticity, acceptability, and feasibility of a hybrid station that combined a standardized patient encounter and a simulated Papanicolaou test. Methods We introduced a hybrid station in the routine clinical skills examination (CSE) for 335 third-year medical students at 4 universities in Korea from December 1 to December 3, 2014. After the tests, we conducted an anonymous survey on the authenticity, acceptability, and feasibility of the hybrid station. Results A total of 334 medical students and 17 professors completed the survey. A majority of the students (71.6%) and professors (82.4%) agreed that the hybrid station was more authentic than the standard CSE. Over 60 percent of the students and professors responded that the station was acceptable for assessing the students’ competence. Most of the students (75.2%) and professors (82.4%) assessed the required tasks as being feasible after reading the instructions. Conclusion Our results showed that the hybrid CSE station was a highly authentic, acceptable, and feasible way to assess medical students’ performance.