The 19th Thai Medical Education Conference Celebrating 20th Anniversary of Mae Fah Luang University Leadership towards Medical Education Excellence December 19-21, 2018 | Mae Fah Luang University

รายงานรวมบทความวิจัย การประชุมวิชาการแพทยศาสตร์ศึกษาแห่งประเทศไทย ครั้งที่ 19 (The 19th Thai Medical Education Conference) “Leadership Towards Medical Education Excellence”

จัดโดย ส ำนักวิชำแพทยศำสตร์ มหำวิทยำลัยแม่ฟ้ำหลวง หัวหน้ำโครงกำร: ศำสตรำจำรย์ นำยแพทย์ ศุภกร โรจนนินทร์ ที่ปรึกษำโครงกำร: ศำสตรำจำรย์เกียรติคุณ พลโท นำยแพทย์ นพดล วรอุไร ชื่อผู้รับผิดชอบโครงกำร: พันเอก นำยแพทย์ โชคชัย เกษจ ำรัส หน่วยงำนรับผิดชอบ: ส ำนักวิชำแพทยศำสตร์ มหำวิทยำลัยแม่ฟ้ำหลวง หน่วยงำนร่วมสนับสนุน: กลุ่มสถำบันแพทยศำสตร์แห่งประเทศไทย (กสพท.)

หลักการและเหตุผล ปัจจุบันกลุ่มสถำบันในระดับอุดมศึกษำที่เปิดสอนหลักสูตรแพทยศำสตร์บัณฑิต ในประเทศไทยมีทั้งหมด 21 แห่ง ผลิตแพทย์ได้ประมำณ 2,700 คนต่อปี กำรรักษำมำตรฐำนและคุณภำพของแพทย์ที่จบออกมำแต่ละปี เป็นขั้นตอนที่มีควำมส ำคัญอย่ำงยิ่งยวด กำรประชุมแพทยศำสตรศึกษำแห่งประเทศไทยจัดขึ้นเพื่อให้มีกำร ปรับปรุงและพัฒนำหลักสูตรดังกล่ำวให้ทันสมัยและครอบคลุมรวมไปถึงกำรพัฒนำวิธี จัดประสบกำรณ์กำร เรียนรู้แก่นักศึกษำแพทย์โดยผ่ำนกำรสนทนำ แลกเปลี่ยนข้อคิด เห็นจำกผู้มีประสบกำรณ์และผู้เชี่ยวชำญในแต่ ละด้ำน และสืบเนื่องจำกกำรเปลี่ยนแปลงครั้งใหญ่ในวงกำรแพทยศำสตร์ศึกษำอเมริกำ AMA (American Medical Association) โดยได้ประกำศว่ำ กำรศึกษำของ แพทย์จะมี 3 pillars แทนที่จะเป็น 2 pillars โดยมี Basic Science, Clinical Science และ Health Systems Science (HSS) และใน pillar ที่ 3 จะครอบคลุม ใน เรื่อง patient safety, quality improvement, evidence-base medicine, value in health care, interprofessional teamwork, stewardship of health care resources, population management, clinical informatics, care coordination, leadership, and health care financing/reform นั่นหมำยถึง แพทย์ที่จบใหม่ต้องรู้จักระบบสำธำรณสุขในภำพ รวมระบบบริกำร ภำครัฐ ระบบกำรจ่ำยยำ ระบบกำรประกัน ตน วิธีกำรพิจำรณำเรื่อง ควำมคุ้มค่ำ ต้นทุน ระบบพัฒนำคุณภำพที่เน้นผู้ป่วยเป็นศูนย์กลำง ดังนั้นกำรประชุม ครั้งนี้ จะเป็นกำรเป็นกำรแลกเปลี่ยนเรียนรู้และสร้ำงองค์ควำมรู้เพื่อพัฒนำกำรศึกษำ ด้ำนแพทยศำสตร์ศึกษำให้ ก้ำวหน้ำ สิ่งส ำคัญงำนประชุมนี้จะเป็นเวทีที่ใช้เผยแพร่ผลงำนวิจัยด้ำนแพทยศำสตร์ศึกษำและน ำไปสู่กำรพัฒนำ งำนวิจัยในอนำคต อันเป็นแนวทำงที่ท ำให้ระบบ กำรศึกษำ หลักสูตรแพทยศำสตร์บัณฑิตยังคงได้รับกำรพัฒนำ ให้มีคุณภำพอย่ำง ไม่มีที่สิ้นสุด

i วัตถุประสงค์ 1. เพื่อให้เข้ำใจ ควำมรู้ด้ำนแพทยศำสตร์ศึกษำที่เปลี่ยนแปลงไป และกำรด ำเนินกำรในกำรเปลี่ยนแปลงนี้ ได้มีกำรด ำเนินกำรอย่ำงไรในสถำบันผลิตแพทย์ในประเทศไทย และในต่ำงประเทศ 2. เพื่อเสริมสร้ำงควำมเข้ำใจในกำรน ำแนวคิด The 3rd Pillars ที่น ำมำใช้ในหลักสูตรกำรเรียนกำรสอน นักศึกษำแพทย์ 3. เพื่อเป็นเวทีแลกเปลี่ยนเรียนรู้และสร้ำงเครือข่ำยด้ำนแพทยศำสตร์ศึกษำ 4. เพื่อส่งเสริมกำรท ำวิจัยด้ำนแพทยศำสตร์ศึกษำของอำจำรย์ บุคลำกรและนิสิตนักศึกษำ 5. เพื่อเป็นขวัญก ำลังใจ และยกย่องครูแพทย์ที่มีผลงำนเป็นที่ประจักษ์ 6. เพื่อร่วมเฉลิมฉลอง 20 ปี แห่งกำรสถำปนำมหำวิทยำลัยแม่ฟ้ำหลวง

สถานที่จัดประชุม ห้องประชุม ประดู่แดง อำคำร E4 มหำวิทยำลัย แม่ฟ้ำหลวง

ii รายนามวิทยากร รายนามวิทยากร 1. นพ.ปัณณวิชญ์ เบญจวลีย์มำศ 33. นพ.จิโรจน์ สูรพันธุ์ 2. ผศ.นพ.อินทนนท์ อิ่มสุวรรณ 34. ศ.เกียรติคุณ พลตรีหญิง พญ.วณิช วรรณพฤกษ์ 3. ดร.นพ.พลพันธ์ บุญมำก 35. ดร.นพ.ปรัชญะพันธุ์ เพชรช่วย 4. รศ.นพ.เชิดศักดิ์ ไอรมณีรัตน์ 36. ศ.นพ.อนันต์ ศรีเกียรติขจร 5. รศ.นพ.ชัชวำลย์ ศิลปกิจ 37. นพ.ดร.ดนัย วังสตุรค 6. ศ.นพ.ชัยรัตน์ ฉำยำกุล 38. ผศ.พญ.กษณำ รักษมณี 7. นพ.วิสุทธิ์ อนันต์สกุลวัฒน์ 39. ผศ.พญ.กนกพร สุขโต 8. รศ.นพ.มนวัฒน์ เงินฉ่ ำ 40. ผศ.พิเศษ นพ.อนุพงษ์ สุธรรมนิรันด์ 9. พญ.ปิยะวรรณ ลิ้มปัญญำเลิศ 41. ศ.นพ.พงษ์ศักดิ์ วรรณไกรโรจน์ 10. ศ.นพ.จรัส สุวรรณเวลำ 42. รศ.นพ.ณัฐพงษ์ อัครผล 11. นพ.รำยิน อโรร่ำ 43. รศ.พญ.กมลวรรณ เจนวิถีสุข 12. นพ.ฑิณกร โนรี 44. ดร.นพ.ชัยสิริ อังกุระวรำนันท์ 13. ศ.ดร.นพ.ประสิทธิ์ วัฒนำภำ 45. รศ.พญ.วิชุดำ จิรพรเจริญ 14. รศ.พญ.นันทนำ ศิริทรัพย์ 46. นพ.ภีม สำระสมบัติ 15. อ. นเรศ สงเครำะห์สุข 47. Prof. Miriam Komaromy 16. นพ.วิวรรธน์ เชี่ยวศิลป์ 48. Mr.Paul Gagnon 17. ผศ.นพ.เทพลักษ์ ศิริธนะวุฒิชัย 18. นพ.วิชช์ เกษมทรัพย์ 19. ผศ.พญ.พัชรินทร์ ปิงเมืองแก้ว 20. ดร.นพ.สุธีร์ รัตนะมงคลกุล 21. นพ.สรรัตน์ เลอมำนุวรรัตน์ 22. ดร.นพ.ชัยยศ คุณำนุสนธิ์ 23. พญ.จิตรลดำ อุทัยพิบูลย์ 24. ดร.นพ.โกมำตร จึงเสถียรทรัพย์ 25. รศ.พญ.ฐิติมำ สุนทรสัจ 26. รศ.พญ.จิตเกษม สุวรรณรัฐ 27. ผศ.ดร.ณัฐฐำศิริ ฐำนะวุฑฒ์ 28. ดร.ปรัชญำนันท์ เที่ยงจรรยำ 29. ศ.นพ.สงวนสิน รัตนเลิศ 30. รศ.ดร.จินตวีร์ คล้ำยสังข์ 31. รศ.ดร.อังคีร์ ศรีภคำกร 32. คุณอรทัย รำชอุ่น

iii กําหนดการ ก าหนดการ การประชุมวิชาการแพทยศาสตร์ศึกษาแห่งประเทศไทยครั้งที่ 19 ณ อาคารเรียนอเนกประสงค์ มหาวิทยาลัยแม่ฟ้าหลวง

วันพุธที่ 19 ธันวาคม 2561 8.30-9.00 เริ่มเปิดรับลงทะเบียน (Registration) 9.00-10.30 Workshop 1: Simulation Teaching and Learning โดย นพ.ปัณณวิชญ์ เบญจวลีย์มำศ คณะแพทยศำสตร์ มหำวิทยำลัยสงขลำนครินทร์ ผศ.นพ.อินทนนท์ อิ่มสุวรรณ คณะแพทยศำสตร์ มหำวิทยำลัยธรรมศำสตร์ ดร.นพ.พลพันธ์ บุญมำก คณะแพทยศำสตร์ มหำวิทยำลัยขอนแก่น Workshop 2: Research in Medical Education โดย รศ.นพ.เชิดศักดิ์ ไอรมณีรัตน์ คณะแพทยศำสตร์ ศิริรำชพยำบำล Workshop 3: Mindfulness towards Professionalism โดย รศ.นพ.ชัชวำลย์ ศิลปกิจ ศูนย์จิตตปัญญำศึกษำ มหำวิทยำลัยมหิดล Workshop 4: Patient Safety in Undergraduate Curriculum โดย ศ.นพ.ชัยรัตน์ ฉำยำกุล คณะแพทยศำสตร์ ศิริรำชพยำบำล นพ.วิสุทธิ์ อนันตสกุลวัฒน์ โรงพยำบำลเจริญกรุงประชำรักษ์ รศ.นพ.มนวัฒน์ เงินฉ่ ำ คณะแพทยศำสตร์ ศิริรำชพยำบำล พญ.ปิยะวรรณ ลิ้มปัญญำเลิศ สถำบันรับรองคุณภำพโรงพยำบำล 10.30-11.00 พักรับประทานอาหารว่าง 11.00-12.00 Workshop 1: Simulation Teaching and Learning (ต่อ) โดย นพ.ปัณณวิชญ์ เบญจวลีย์มำศ คณะแพทยศำสตร์ มหำวิทยำลัยสงขลำนครินทร์ ผศ.นพ.อินทนนท์ อิ่มสุวรรณ คณะแพทยศำสตร์ มหำวิทยำลัยธรรมศำสตร์ ดร.นพ.พลพันธ์ บุญมำก คณะแพทยศำสตร์ มหำวิทยำลัยขอนแก่น Workshop 2: Research in Medical Education (ต่อ) โดย รศ.นพ.เชิดศักดิ์ ไอรมณีรัตน์ คณะแพทยศำสตร์ ศิริรำชพยำบำล Workshop 3: Mindfulness towards Professionalism (ต่อ) โดย รศ.นพ.ชัชวำลย์ ศิลปกิจ ศูนย์จิตตปัญญำศึกษำ มหำวิทยำลัยมหิดล Workshop 4: Patient Safety in Undergraduate Curriculum (ต่อ) โดย ศ.นพ.ชัยรัตน์ ฉำยำกุล คณะแพทยศำสตร์ ศิริรำชพยำบำล นพ.วิสุทธิ์ อนันตสกุลวัฒน์ โรงพยำบำลเจริญกรุงประชำรักษ์ รศ.นพ.มนวัฒน์ เงินฉ่ ำ คณะแพทยศำสตร์ ศิริรำชพยำบำล พญ.ปิยะวรรณ ลิ้มปัญญำเลิศ สถำบันรับรองคุณภำพโรงพยำบำล 12.00-13.00 รับประทานอาหารกลางวัน

iv 13.00-14.30 พิธีเปิดการประชุมแพทยศาสตร์ศึกษาแห่งประเทศไทยครั้งที่ 19 (Opening Ceremony) และพิธีมอบรางวัลครูแพทย์แห่งชาติ โดยคณะกรรมกำรวิชำกำรกลุ่มสถำบันแพทยศำสตร์แห่งประเทศไทย 14.30-15.00 พักรับประทานอาหารว่าง 15.00-16.00 Key note Lecture 1: Medical Curriculum that Serves the National Health Care (หลักสูตรแพทย์ที่ตอบสนองต่อภาคสุขภาพของประเทศ) โดย ศ.นพ.จรัส สุวรรณเวลำ ประธำนกรรมกำรคณะกรรมกำรอิสระเพื่อกำรปฏิรูปกำรศึกษำ 16.00-17.30 Plenary Session 1 Health System Science: The 3rd Pillar in Undergraduate Medical Education โดย นพ. รำยิน อโรร่ำ ผู้ช่วยอธิกำรบดีวิทยำลัยวิทยำศำสตร์กำรเเพทย์เจ้ำฟ้ำจุฬำภรณ์รำชวิทยำลัยจุฬำภรณ์ 17.30-18.30 Welcome Reception 18.30-20.00 Faculty dinner by invitation

วันพฤหัสบดีที่ 20 ธันวาคม 2561 9.00-10.30 Key note Lecture 2: Medical Education towards the MoPH Strategy: “People Excellence” โดย ดร.นพ.ฑิณกร โนรี Plenary Session 2: Transforming Medical Education for Future Society โดย ศ.ดร.นพ.ประสิทธิ์ วัฒนำภำ นำยกแพทยสภำ

รศ.พญ.นันทนำ ศิริทรัพย์ ผู้แทนเลขำธิกำรกลุ่มสถำบันแพทยศำสตร์แห่งประเทศไทย อำจำรย์นเรศ สงเครำะห์สุข ผู้แทนภำคประชำชน 10.30-11.00 พักรับประทานอาหารว่าง Symposium 1: Complementary and Alternative Medicine 11.00-12.00 โดย ผศ.นพ.เทพลักษ์ ศิริธนะวุฒิชัย

คณะแพทยศำสตร์ มหำวิทยำลัยมหำสำรคำม

พจ.กรกช รักษ์เพชร โรงพยำบำลมหำวิทยำลัยแม่ฟ้ำหลวง

นพ.สกล บุญญประภำ ส ำนักวิชำแพทยศำสตร์ มหำวิทยำลัยแม่ฟ้ำหลวง

นพ.วิวรรธน์ เชี่ยวศิลป์ ส ำนักวิชำแพทยศำสตร์ มหำวิทยำลัยแม่ฟ้ำหลวง

v 11.00-12.00 Symposium 2: Faculty Development in New Medical School โดย ศ.เกียรติคุณพลตรีหญิง พญ.วณิช วรรณพฤกษ์ คณะแพทยศำสตร์ มหำวิทยำลัยมหำสำรคำม ดร.นพ.ปรัชญะพันธุ์ เพชรช่วย ส ำนักวิชำแพทยศำสตร์ มหำวิทยำลัยวลัยลักษณ์ ศ.นพ.อนันต์ ศรีเกียรติขจร คณะแพทยศำสตร์ สถำบันเทคโนโลยีเจ้ำคุณทหำรลำดกระบัง Symposium 3: Health System Science in Undergraduate Curriculum โดย นพ.วิชช์ เกษมทรัพย์ คณะแพทยศำสตร์ โรงพยำบำลรำมำธิบดี ดร.นพ.สุธีร์ รัตนะมงคลกุล คณะแพทยศำสตร์ มหำวิทยำลัยศรีนครินทรวิโรฒ ผศ. พิเศษ นพ. อนุพงษ์ สุธรรมนิรันด์ รองผู้อ ำนวยกำรส ำนักงำนบริหำรโครงกำรผลิตแพทย์เพิ่มเพื่อชำวชนบท 12.00-13.00 Lunch symposium 1: Community Research: Sharing Experiences from MFU โดย ดร.นพ.ชัยยศ คุณำนุสนธิ์ โรงพยำบำลกรุงเทพ พญ.จิตรลดำ อุทัยพิบูลย์ ส ำนักวิชำแพทยศำสตร์ มหำวิทยำลัยแม่ฟ้ำหลวง 13.00-14.30 Key note Lecture 3: Medical Humanities in the 21st Century (มานุษยวิทยาการแพทย์ ศตวรรษที่ 21) โดย ดร.นพ.โกมำตร จึงเสถียรทรัพย์ ส ำนักวิจัยสังคมและสุขภำพ ส ำนักนโยบำยและยุทธศำสตร์ กระทรวงสำธำรณสุข 14.30-15.00 พักรับประทานอาหารว่าง Oral and Poster Presentation 15.00-16.00 โดยคณะกรรมกำรวิชำกำรกลุ่มสถำบันแพทยศำสตร์แห่งประเทศไทย 16.00-17.30 Symposium 4: Inter-professional Education: The Beauty among Differences โดย รศ.พญ.ฐิติมำ สุนทรสัจ คณะแพทยศำสตร์มหำวิทยำลัยสงขลำนครินทร์ รศ.พญ.จิตเกษม สุวรรณรัฐ คณะแพทยศำสตร์ มหำวิทยำลัยสงขลำนครินทร์ ผศ.ดร.ณัฐฐำศิริ ฐำนะวุฑฒ์ คณะเภสัชศำสตร์ มหำวิทยำลัยสงขลำนครินทร์ ดร.ปรัชญำนันท์ เที่ยงจรรยำ คณะพยำบำลศำสตร์ มหำวิทยำลัยสงขลำนครินทร์ Symposium 5: Good Practice in Formative and Summative Assessment โดย นพ. ดร.ดนัย วังสตุรค คณะแพทยศำสตร์จุฬำลงกรณ์มหำวิทยำลัย ผศ.พญ.กษณำ รักษมณี คณะแพทยศำสตร์ ศิริรำชพยำบำล มหำวิทยำลัยมหิดล ผศ.พญ.กนกพร สุขโต คณะแพทยศำสตร์ โรงพยำบำลรำมำธิบดี

vi 16.00-17.30 Symposium 6: Technology Enhanced-Learning: Time to Start โดย Paul Gagnon Lee Kong Chian School of Medicine, Nanyang Technological University รศ.ดร.จินตวีร์ คล้ำยสังข์ คณะครุศำสตร์ จุฬำลงกรณ์มหำวิทยำลัย รศ.ดร.อังคีร์ ศรีภคำกร คณะวิศวกรรมศำสตร์ จุฬำลงกรณ์มหำวิทยำลัย Symposium 7: Tele-conference Expansion on Community Health Outcomes (ECHO) program for Primary Care Services โดย Prof. Miriam Komaromy, University of New Mexico รศ.พญ.วิชุดำ จิรพรเจริญ ดร.นพ.ชัยสิริ อังกุระวรำนันท์ นพ.ภีม สำระสมบัติ คณะแพทยศำสตร์ มหำวิทยำลัยเชียงใหม่ 17.30-20.00 Congress dinner

วันศุกร์ที่ 21 ธันวาคม 2561 Panel Discussion 1: Medical Curriculum Development for National Health 9.00-10.30 Needs โดย รศ.พญ.จิตเกษม สุวรรณรัฐ คณะแพทยศำสตร์ มหำวิทยำลัยสงขลำนครินทร์ นพ.สรรัตน์ เลอมำนุวรรัตน์ ผู้อ ำนวยกำรศูนย์แพทยศำสตรศึกษำชั้นคลินิก โรงพยำบำลมหำรำชนครรำชสีมำ รศ.ดร.วรำภรณ์ เอี้ยวสกุล ส ำนักวิชำแพทยศำสตร์ มหำวิทยำลัยแม่ฟ้ำหลวง Panel Discussion 2: Accreditation: Lesson Learned from Assessors and Medical School โดย ศ.นพ.พงษ์ศักดิ์ วรรณไกรโรจน์ คณะแพทยศำสตร์จุฬำลงกรณ์มหำวิทยำลัย รศ.นพ.ณัฐพงษ์ อัครผล คณะแพทยศำสตร์ มหำวิทยำลัยเชียงใหม่ รศ.พญ.กมลวรรณ เจนวิถีสุข คณะแพทยศำสตร์มหำวิทยำลัยขอนแก่น ดร.นพ.ปรัชญะพันธุ์ เพชรช่วย ส ำนักวิชำแพทยศำสตร์ มหำวิทยำลัยวลัยลักษณ์ พญ.จิตรลดำ อุทัยพิบูลย์ ส ำนักวิชำแพทยศำสตร์ มหำวิทยำลัยแม่ฟ้ำหลวง Panel Discussion 3: Student Affair Network Session Extracurricular Activities Strengthen Educational Outcomes โดยสมำพันธ์นิสิตนักศึกษำแพทย์แห่งประเทศไทย Panel Discussion 4: Medical Education Staff Session: Roles for Educational Outcome, Monitoring and Evaluation โดยเจ้ำหน้ำที่ และนักวิชำกำรด้ำนแพทยศำสตรศึกษำ 10.30-11.00 พักรับประทานอาหารว่าง

11.00-12.00 Plenary Session 3: Update in Medical Education โดย คณะท ำงำนวิชำกำร กลุ่มสถำบันแพทยศำสตร์แห่งประเทศไทย

vii

12.00-13.00 Presentation Awards, Take Home Message and Closing Ceremony โดยคณะกรรมกำรวิชำกำร กลุ่มสถำบันแพทยศำสตร์แห่งประเทศไทย 13.00-14.00 รับประทานอาหารกลางวัน

viii สารบัญ เรื่อง หน้า

รำยละเอียดกำรประชุมวิชำกำรแพทยศำสตร์ศึกษำแห่งประเทศไทย ครั้งที่ 19 i รำยนำมวิทยำกร iii ก ำหนดกำรกำรประชุมวิชำกำรแพทยศำสตร์ศึกษำแห่งประเทศไทย ครั้งที่ 19 iv ผลงำนวิชำกำร (Abstract) 1-48 − FP01 INFORMATION TECHNOLOGY – ENHANCED PATHOLOGY EDUCATION 1 − FP02 The Efficacy of Pediatric Elbow Radiographic Guidance in Diagnosis of 2 Lateral Humeral Condyle Fracture − FP03 Effectiveness of E-learning in Metabolic Bone Diseases for the Fifth- 3 Year Medical Students − FP04 Training Physicians to Deliver Bad News Using Peer Role Play 5 Compared to Standardized Patients − FP05 Residents as Teachers: Students’ Perspectives 6 − FP06 Teaching History of Medical History for Second Year Medical 7 Students − FP07 Impact study of examination entrance process for the third year 8 medical students using lean concept − FP08 TELECONFERENCING COULD BRING MORE EDUCATION TO THE 10 HEALTH CARE TEAM IN OUR NEW MEDICAL ERA − FP09 Impact of increased active learning in medical microbiology teaching 11 on medical student learning outcomes − FP10 Underestimation of learning outcome achievement of students by 12 traditional two-step thinking single-best answer-multiple choice question: A study in a medical microbiology course of preclinical year medical students − FP11 The Medical Students Perspective For Early Experimental Clinical 13 Exposure In Preclinical Year Instruction Program − FP12 Correlation between Kolb’s Learning Styles (KLS), GPAX and VARK 14 Learning Styles in Pre-clinical Medical Students. − FP13 Active learning in perspective of pre-clinical medical student, 15 Thailand

ix สารบัญ เรื่อง หน้า

− FP14 An Innovative Learning Method by Modified Thailand’s TV Game- 16 show in Pre-clinical Medical Education, Mae Fah Luang University: Pilot Study. − FP16 The Effects of Jasmine Oil inhalation on stress in preclinical male 17 medical students At Mae Fah Luang University − FP17 Training the Physical Medicine and Rehabilitation Residents as a 18 Teaching Assistant for Medical Students − FP21 Medical student perception in different types of formative 19 evaluation score feedback − FP22 Transition from Paper-Based to Electronic Portfolio using on-Hand 20 Social Medias for Medical Students − FP23 Factors affecting decision to study in Master degree of Medical 21 Technologist − FP24 Comparative Study of Learning Outcomes on Safety Blood 23 Transfusion Using in-Class Didactic Versus Multimedia-Based Teaching in Sixth Year Medical Student at Phramongkutklao Hospital and College of Medicine − FP26 Stress and Socio-demographic Factors Related to Empathy among 24 Medical Students in Faculty of Medicine Vajira Hospital − FP27 The Bmboc-Gamification as an Innovative Tool of Medical Education 26 in Phramongkutklao College of Medicine − FP28 Body painting: A tool for learning cutaneous nerve of leg in 27 preclinical medical students − FP29 Admission of Medical Student in Phramongkutklao College of 28 Medicine Through Tcas − FP30 Applications Electronic-Immediate Feedback Assessment Technique 29 (E-Ifat Ps@Pcm) Program Instead of the Ifat Answer Paper − FP31 Quick Response for Evaluation of Clinical Practice in Medical Student 30 − FP32 Learning Style Preferences in 2-Year Medical Cadets and Academic 31 Scores of 4-Block Systems

x สารบัญ เรื่อง หน้า

− FP33 Changes in Positive Psychology Attitudes after Watching Movies: A 32 Medical Student Study − FP34 Effects of Learning Methods for Lecture on Academic Achievement 33 of Preclinical Medical Students − FP36 The Development of Communication Skills of First Year Medical 34 Students Through Health Interview Activities − FP37 First Year Medical Students’ Reflections on community immersion: 35 CPIRD program at Prince of Songkla University − FP38 A Generalizability Theory Approach to Estimate Generalizability and 36 Dependability Coefficients of the Assessment from Multiple Perspectives for Innovative Media to Promote Health Awareness. − FP39 Test-Enhanced Case-Based Learning: A Randomized Trial 37 − FP40 Structured Reflective Writing to Increase Confidence Levels in 38 Emergency Obstetric Anesthesia of Nurse Anesthetist Students − FP41 The Satisfaction of Using Moodle for Studying Infectious Diseases and 39 Immunology (Microbiology Part) − FP42 Frontiers of Learning in Internal Medicine in 21 st Century 41 − FP43 "Objectively-Defined, Facilitator-Guided Case Discussion: A Tool to 42 Promote Learning And Cultivating 21st Century Skills" − FP44 Affecting Factors for Retention in Health System of New Doctors 43 from Suranaree University of Technology. − FP45 Comparison of Grade Point Average and the Pass of Medical License 44 Examination in the Pre-Clinical Medical Students − FP46 Evidence-based medicine: A survey among 5th year medical 45 students of Suranaree University of Technology − FP47 "An Ethical Challenge for The Students of Medicine: Coercion in 46 Psychiatric Inpatient Treatment" ผลงำนวิชำกำร (Proceeding) 47-79 − FP04-Training Physicians to Deliver Bad News Using Peer Role Play 47 Compared to Standardized Patients

xi สารบัญ เรื่อง หน้า

− FP31-Quick Response for Evaluation of Clinical Practice in Medical Student 56 − FP39-Test-Enhanced Case-Based Learning A Randomized Trial 62 − FP40-Structured Reflective Writing to Increase Confidence Levels in 68 Emergency Obstetric Anesthesia of Nurse Anesthetist Students ค ำสั่งแต่งตั้งคณะกรรมกำรพิจำรณำผลงำนวิชำกำร กำรประชุมวิชำกำรแพทยศำสตรศึกษำแห่ง 80 ประเทศไทย ครั้งที่ 19

xii ผลงานวิชาการ (Abstract) The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

INFORMATION TECHNOLOGY – ENHANCED PATHOLOGY EDUCATION

Mongkon Charoenpitakchai1*, Thirayost Nimmanon1, Chetana Ruangpratheep1, Pipat Sritanabutr1, and Sumeth Termmathurapoj1

1 Department of Pathology, Phramongkutklao College of Medicine, Floor 6, Her Royal Highness Princess Bejaratana Building, 315 Rajavithi Road, Rajadevi, 10400 Bangkok, Thailand

*Corresponding Author’s E-mail: [email protected]

Abstract

Pathology plays a central role in the study of modern medicine because it is the study of structural and functional abnormalities that manifest as diseases of organs and systems. The use of current information technology can promote student learning outcomes in general and systemic pathology. Hence, Department of Pathology, Phramongkutklao College of Medicine has applied virtual microscopy (VM), real-time interactive telelecture system, and YouTube video-based review to the undergraduate pathology lectures and practicals since the academic year 2016. The VM system transforms the structure of all histopathology laboratory sessions to team-based learning (TBL). Contrary to the traditional light microscope-based teaching of pathology, the medical students and the teachers can truly identify any lesions on the same tissue slide at the same time in collaborative groups. For the real-time interactive telelecture system, the lecturers can instruct and discuss with the medical students in a telelecture classroom, in a real-time manner. The medical students can ask their own interested questions, and get responses simultaneously. Furthermore, the concepts of general and systemic pathology are summarised on videos uploaded to YouTube. These videos are used as a supplement for study and for review. During the access to our online review, the third-year medical students are able to confirm the strength of their knowledge about pathology and uncover areas of weakness by themselves. In conclusion, the state-of-the-art information and communication technologies facilitate a successful active learning in undergraduate pathology course.

Keywords: Information technology, Pathology, Telelecture system, Virtual microscopy, YouTube video

1 FP01

The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

The Efficacy of Pediatric Elbow Radiographic Guidance in Diagnosis of Lateral Humeral Condyle Fracture

Chanika Angsanuntsukh MD*, Satetha Vasaruchapong MD*, Patarawan Woratanarat MD PhD*

Faculty of Medicine Ramathibodi Hospital

Email: [email protected]

Abstract

Background: Although lateral condyle fracture is common, the incidence of missed diagnosis is very high. Delayed and missed diagnosis lead to significant morbidities and loss of functions. Objective: The authors designed a pediatric elbow radiographic guidance aiming to improve the accuracy of diagnosis. This study aimed to evaluate the efficacy of the guidance. Materials and methods: A cross- sectional study was conducted from 2015 to 2016. After guidance development, a questionnaire was designed to evaluate the efficacy of the guidance. All participants were asked to complete pretest evaluation, followed by study the guidance, and then finished posttest evaluation. Baseline characteristics, diagnostic scores, and parameter evaluation scores were collected. Pretest and posttest scores were analyzed using paired t-test. Association between baseline characteristics and diagnostic scores were analyzed using multiple regression analysis. Results: Total of 177 participants were included. Mean of diagnostic scores was significantly improved after using the guidance, 12.4 + 2.0 to 13.4 + 1.4 (p < 0.003). Medical student was the most improved, 11.9 + 1.9 to 13.1 + 1.3 (p <0.001). Conclusion: Pediatric elbow radiographic guidance is beneficial for evaluation and diagnosis, especially for young physicians and trainees. Therefore, the guidance is recommended in routine medical education and practice.

2 FP02 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

EFFECTIVENESS OF E-LEARNING IN METABOLIC BONE DISEASES FOR THE FIFTH-YEAR MEDICAL STUDENTS

Tulyapruek Thawonsawatruk1, Patarawan Woratanarat1*, Thira Woratanarat2, Thirawat Woratanarat3, Wiwat Wajanavisit1, Sukij Laohacharoensombant1, Adisak Narthanarung1, Pennapa Aubcherye1, Narin Aubcherye1, and Butsakorn Noysang1

1 Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, 10400, Bangkok, Thailand. 2 Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV, Pathumwan, 10330, Bangkok, Thailand. 3 Saint Gabriel’s College, 565 Samsen Road, Dusit, 10300, Bangkok, Thailand.

*Corresponding Author’s E-mail: [email protected]

Abstract

E-learning is a tool for enhancing knowledge. It would support medical students’ learning ability to understand complex metabolic bone diseases. This study aimed to assess the effectiveness of e-learning in metabolic bone diseases among medical students in orthopaedic rotation. A retrospective cohort was conducted at Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital. The fifth-year medical students were enrolled between August 2012 and July 2013. The students who missed the class were excluded. All participants were informed to study metabolic bone diseases from a lesson plan, handouts, a textbook, and voluntarily participate in e-learning prior to attend a one-hour case- based lecture. Baseline characteristics, in-class score, multiple choice question (MCQ) grade, and orthopaedic grade were collected. The relationship between study factors and the outcomes were analyzed using multiple regression analysis. There were 154 medical students included in the study. Average age was 23 years, and 57% of them were female. Only 12 (8%) of them participated in e- learning. E-learning group demonstrated higher in-class score (9.00 + 0.95) when compared with non e-learning group (7.70 + 1.30) with p-value = 0.001. Cumulative GPA and e-learning group were significant factors included in multiple regression. After adjusted for cumulative GPA, e-learning was significantly related to in-class score (coefficient 1.20, 95% confidence interval 0.43, 1.96, p-value = 0.002). E-learning did not significantly correlate with MCQ grade and orthopaedic grade. E-learning is effectively increase knowledge in metabolic bone disorders among medical students. However, it does not relate with MCQ grade and orthopaedic grade.

Keywords: diseases, effectiveness, e-learning, medical student, metabolic

3 FP03 การประชุมวิชาการแพทยศาสตร์ศึกษาแห่งประเทศไทย ครั้งที่ 19 19-21 ธันวานคม 2561 ณ มหาวิทยาลัยแม่ฟ้าหลวง ภายใต้หัวข้อ “Leadership Towards Medical Education Excellence”

ประสิทธิภาพของ e-learning ในโรคกระดูกเมตาโบลิกส าหรับนักศึกษาแพทย์ปี 5

ตุลยพฤกษ์ ถาวรสวัสดิ์รักษ์1, ภัทรวัณย์ วรธนารัตน์1*, ธีระ วรธนารัตน์2, ธีระวัฒน์ วรธนารัตน์3, วิวัฒน์ วจนะวิศิษฐ1, สุกิจ เลาหเจริญสมบัติ1, อดิศักดิ์ นารถธนะรุ่ง1, เพ็ญนภา อบเชย1, นรินทร์ อบเชย1, บุษกร น้อยแสง1

1 ภาควิชาออร์โธปิดิกส์ คณะแพทยศาสตร์โรงพยาบาลรามาธิบดี มหาวิทยาลัยมหิดล, 270 ถนนพระราม 6 เขตราชเทวี กรุงเทพฯ 10400 2 ภาควิชาเวชศาสตร์ป้องกันและสังคม คณะแพทยศาสตร์ จุฬาลงกรณมหาวิทยาลัย, 1873 ถนนพระราม 4 เขตปทุมวัน กรุงเทพฯ 10330 3 โรงเรียนเซนต์คาเบรียล, 565 ถนนสามเสน เขตดุสิต กรุงเทพฯ 10300

E-mail ของผู้ประสานงาน: [email protected]

บทคัดย่อ

E-learning เป็นเครื่องมือช่วยในการเรียนรู้ อาจสนับสนุนนักศึกษาแพทย์ปี 5 ให้เข้าใจโรคกระดูกเมตาโบลิก การศึกษานี้มุ่งประเมินประสิทธิภาพของ e-learning เรื่องโรคกระดูกเมตาโบลิกในนักศึกษาแพทย์ที่ผ่านออร์โธปิดิกส์ โดย ท าการศึกษา retrospective cohort ที่ภาควิชาออร์โธปิดิกส์ คณะแพทยศาสตร์โรงพยาบาลรามาธิบดี รวบรวมนักศึกษา แพทย์ปี 5 ช่วงสิงหาคม 2555 ถึงกรกฎาคม 2556 นักศึกษาแพทย์ขาดเรียนจะได้รับการคัดออก ผู้เข้าร่วมวิจัยศึกษาบทเรียน เอกสารคาสอน ต ารา และดู e-learning ตามความสมัครใจ จากนั้นเรียน case-based lecture 1 ชั่วโมง เก็บข้อมูลพื้นฐาน คะแนนทดสอบในห้องเรียน เกรดของข้อสอบปรนัยและออร์โธปิดิกส์ หาความสัมพันธ์ระหว่างปัจจัยที่เกี่ยวข้องกับผล การศึกษาโดยใช้ multiple regression มีนักศึกษาแพทย์ 154 ราย อายุเฉลี่ย 23 ปี ร้อยละ 57 เป็นหญิง เข้าดู e-learning เพียง 12 ราย (ร้อยละ 8) กลุ่มที่ดู e-learning มีคะแนนทดสอบในห้องเรียน (9.00 + 0.95) สูงกว่ากลุ่มที่ไม่ได้ดู (7.70 + 1.30) ด้วย p-value = 0.001 เกรดเฉลี่ยสะสมและ e-learning เป็นปัจจัยส าคัญใน multiple regression หลังจากควบคุมเกรด เฉลี่ยสะสมพบว่า e-learning สัมพันธ์กับคะแนนทดสอบในห้องเรียน (coefficient 1.20, 95% confidence interval 0.43, 1.96, p-value = 0.002) แต่ไม่มีความสัมพันธ์กับเกรดของข้อสอบปรนัยและเกรดออร์โธปิดิกส์ e-learning มีประสิทธิภาพ เพิ่มความรู้เรื่องโรคกระดูกเมตาโบลิกในนักศึกษาแพทย์ แต่ไม่มีความสัมพันธ์กับเกรดของข้อสอบปรนัยและเกรดออร์โธปิดิกส์

ค าส าคัญ: โรค, ประสิทธิภาพ, e-learning, นักศึกษาแพทย์, เมตาโบลิก

4 FP03 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

TRAINING PHYSICIANS TO DELIVER BAD NEWS USING PEER ROLE PLAY COMPARED TO STANDARDIZED PATIENTS

Kamoltip Lertchaisataporn MD 1*, Cherdsak Iramaneerat MD, PhD 2, and Supot Pongprasobchai MD 3

1 Master of Science Program in Health Science Education, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd. Bangkoknoi Bangkok 10700 Thailand. 2Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd. Bangkoknoi Bangkok 10700 Thailand. 3Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd. Bangkoknoi Bangkok 10700 Thailand.

*Corresponding Author’s E-mail: [email protected]

Abstract

Introduction: There is a lack of studies comparing the effectiveness of using standardized patients (SP) and peer role-playing (PRP) for training breaking bad news (BBN). Objectives: To investigate the effectiveness of training physicians to BBN using PRP compared to SP and to examine the participants’ perspectives on their satisfaction and the perceived effect of training. Methods: Thirty-four physicians were assigned into two groups receiving BBN training with PRP or SP in a one-day workshop. The communication skills were evaluated using the Gap–Kalamazoo Communication Skills Assessment Form with one SP encounter at the pre-workshop and two SP encounters at the post-workshop. The questionnaires inquired about the participants’ perspectives on their satisfaction. Results: For PRP group, the posttest scores were significantly higher (35.7 ± 1.75) than for the pretest (27.4 ± 1.99), p < 0.001. For SP group, the posttest scores (36.7 ± 2.78) were also higher than for the pretest (29.2 ± 2.36), p < 0.001. The increased scores were not significantly different for the PRP group (8.28 ± 2.17) and the SP group (7.51 ± 3.52), p = 0.45. The participant’s perspectives on the satisfaction and the perceived effect of communication training showed no significant difference in both groups. Conclusion: The physicians practiced using either PRP or SP, could yield a significant improvement in BBN skills. There was no statistically significant difference between the use of PRP and SP. Both methods seemed comparable for the BBN skill training and were very well accepted.

Keywords: doctor-patient communication, peer role-play, standardized patients, breaking bad news, communication skills training.

5 FP04 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

RESIDENTS AS TEACHERS: STUDENTS’ PERSPECTIVES

Sakarn Charoensakulchai1*, Anupong Kantiwong1,

1 Phramongkutklao College of Medicine, 317/5 Rajwithee Rd, Rajthewi District, Bangkok, Thailand, 10400

*Corresponding Author’s E-mail: [email protected]

Abstract

Clinical medical students need to find suitable learning resource persons (LRPs) to cope with knowledge and develop their skills. There are varying LRP among health-care providers of which residents are considered one of it. Our study aimed to explore the efficacy of residents’ role as teachers towards 6 aspects comparing to staffs, peers and self-learning in medical students’ perspectives. 142 medical students responded to a 5-rating scale questionnaire covering 6 aspects; knowledge acquired, accuracy of information, clinical skills, active learning stimulation, comfortable learning environment and time consuming for assess all LRPs. Statistical analysis was compared outcomes between groups of resource person by using one-way ANOVA and exploratory factor analysis (EFA).From the survey, residents had received the highest mean score. There are significantly difference perspectives between all 4 LRPs (F=40.2,p=0.001). Subgroup analysis revealed that residents had significantly higher mean differences than staffs (MD=1.13,p=0.010), peers (MD=3.20,p=0.001) and self-learning (MD=3.25,p=0.001). Fourth years’ perspectives did not had significant difference between residents and staffs (MD=0.94,p=0.527), in contrast to the fifth years’ perspectives (MD=1.58,p=0.024). EFA displayed that residents had largest factor loading toward comfortable learning environment (λ=0.813) and a large factor loading toward time consuming second only to peers (λ=0.796). Residents received positive results and highly effective in enhancing student achievement because fewer age gap and more working time with residents also allowed a more comfortable environment for medical students to approach, discuss and practice together.

Keywords: Residents, Teachers, Students, Resource Persons

6 FP05 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

Teaching History of Medical History for Second Year Medical Students

Mrs. Siriporn Intarat, Mr. Pannawit Benjhawaleemas, Mr. Somchai Suntornlohanakul, Mrs. Pantip Chayakul. Mrs. Junya Nakarin, Mrs. Koramas Sanguasa, Mrs, Srisupon Piyaratanawong, Mr. Jindaporn Puripattanavong, Miss. Shutiwan Purinthrapibal, Miss Phatsasi Laojeenwong

Faculty of Medicine, Faculty of Liberal Arts, Faculty of Pharmacy, Faculty of Nursing, and Thai Traditional Medicine, Prince of Songkla University

E-mail: [email protected]

Abstract

Introduction: In 1999, The Faculty of Medicine Prince of Songkla University improved its Curriculum of Medicine bachelor. in order to develop the teaching course of medical history. Objective: To evaluate teaching and learning Study: A record form of observed, learning behavior of students from teachers. Self-evaluation Assessment of achievement by professors and examiners. Analyze data using percentage and mean. Result: The teaching and learning process of the students was at a high level. Interestingly, the teaching Content was suitable for the purpose, and contained enough media to promote learning. Be prepared to Manage and provide course information. The attitude towards learning behavior was at a high level. To participate in team work activities on a regular basis, students can think, analyze and solve problems. Working on schedule with the use of technology, dress and personality Self-assessment on learning was at a high level. Students had a chance to ask questions, participate in discussions and make comments. Learners can learn from the lectures, to learn the ability to manage time, and other learning activities. Think logically. Work on a schedule. Student achievement was high. Conclusion: The results of the evaluation of the teaching and learning curriculum, in medical history, were at a good level. Teachers and students have a positive attitude towards teaching and learning. Achievement is high.

Keywords: behavioral management, attitude, behavior, medical history

7 FP06 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

Impact study of examination entrance process for the third year medical students using lean concept

Nuttamon Sridathon1, Pakanut Supaprasert2, Phachadapan Odompet3, Ananya Pongpaibul4, Ngoentra Tantranont5

1,2,3Education Department, Division of Medical Education, 3,4Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.

[email protected]

Abstract

Context: More than 20 examinations are held for more than 300 medical students throughout the year. The new entrance process is applied in 2016 using “lean concept”. Objectives: The goal of this study was to explore the impact of this new entrance process. Methods: Semi-structured interviews were conducted with 15 third year medical students, 4 teachers and 5 administrative personals. Every examination was directly observed and documented by researchers. Results: Three aspects revealed the impact of this new entrance process: (i) the process was well- managed and fair, reduced hectic and noisy environment during the entrance period, reduced number of late examiners; (ii) the process trained discipline for medical student; (iii) the medical student had stress during the entrance process. The direct observation demonstrated similar findings; reduced hectic and noisy environment and decreased number of late examiners comparing with the previous year. Conclusions: This new entrance process had both positive and negative impacts. The standardized process was necessary in order to arrange a fair examination for a large number of examiners within the limited spaces and resources. The medical student did not familiar with rules and regulations leading to stress during the process. The well communicated instruction may alleviate the stress.

Keywords: examination, medical students, lean concept

8 FP07 การประชุมวิชาการแพทยศาสตร์ศึกษาแห่งประเทศไทย ครั้งที่ 19 19-21 ธันวานคม 2561 ณ มหาวิทยาลัยแม่ฟ้าหลวง ภายใต้หัวข้อ “Leadership Towards Medical Education Excellence”

การศึกษาผลกระทบจากการบริหารจัดการเข้าห้องสอบส าหรับนักศึกษาแพทย์ชั้นปีที่ 3 โดยการประยุกต์ใช้แนวคิดลีน นัทธมน ศรีดาทน1, ภคณัท ศุภประเสริฐ2, พัชดาพรรณ อุดมเพ็ชร3 ผศ.พญ.อนัญญา พงษ์ไพบูลย์4, อ.พญ.เงินตรา ทันธรานนท์5 1ฝ่ายการศึกษา, 2ภาควิชาพยาธิวิทยา คณะแพทยศาสตร์ศิริราชพยาบาล 2 ถนนวังหลัง แขวงศิริราช เขตบางกอกน้อย กทม. 10700 [email protected]

บทคัดย่อ ที่มา: การจัดสอบส าหรับนักศึกษาชั้นปีที่ 3 คณะแพทยศาสตร์ศิริราชพยาบาลในแต่ละปีมีจ านวนมากกว่า 20 ครั้ง และจัด สอบส าหรับนักศึกษามากกว่า 300 คน ปีพ.ศ. 2559 ได้มีการริเริ่มปรับปรุงการบริหารจัดการเข้าห้องสอบโดยการประยุกต์ใช้ แนวคิดลีน วัตถุประสงค์: เพื่อศึกษาผลกระทบของการบริหารจัดการเข้าห้องสอบ วิธีการศึกษา: สัมภาษณ์นักศึกษาแพทย์จ านวน 15 คน อาจารย์ 4 คน และ เจ้าหน้าที่ด าเนินการจัดสอบ 5 คน ผลการศึกษา: ผลกระทบจากการบริหารจัดการเข้าสอบมี 3 ด้าน ได้แก่ กระบวนการดังกล่าวมีระบบระเบียบและมีความ ยุติธรรม กระบวนการดังกล่าวช่วยฝึกฝนระเบียบวินัยแก่นักศึกษาแพทย์ และ พบมีความเครียดในระหว่างการเข้าห้องสอบ สรุป: การบริหารจัดการเข้าห้องสอบ มีผลกระทบทั้งในทางบวกและลบ กระบวนการที่เป็นมาตรฐาน มีความจ าเป็นในการ จัดการสอบให้มีความยุติธรรมโดยเฉพาะการจัดสอบส าหรับนักศึกษาจ านวนมาก กระบวนการดังกล่าวส่งผลให้เกิดความเครียด ในนักศึกษาที่ยังไม่คุ้นเคยกับขั้นตอนกระบวนการ การสื่อสารให้นักศึกษารับทราบและเข้าใจกระบวนการก่อนการสอบ อาจจะ ท าให้ลดความเครียดลงได้

ค าส าคัญ : การจัดสอบ , นักศึกษาแพทย์ , แนวคิดลีน

9 FP07 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

TELECONFERENCING COULD BRING MORE EDUCATION TO THE HEALTH CARE TEAM IN OUR NEW MEDICAL ERA

Dr. Vich Thampanya, M.D.* Dr Thanapat Kittipanyaworakun, M.D. Dr. Nonlawan Cheuamuangphan, M.D.Ph.D. and Dr. Chulaphong Chan-ta, M.D. Medical Education Center, Chiangrai Prachanukroh Hospital

*corresponding author’s email address : [email protected]

Abstract

Introduction: Chiang Rai Prachanukroh General Hospital has developed a knowledge-based system to bring knowledge to the network team hospitals in all Lanna No.3's group.that saves money and increases adherence. Objectives: The teleconferencing system team studied the satisfaction of both directions in order to see benefits to the community health staff. Method: Online questionnaires through Google forms after each lecture was done. Summary of results: The data showed the satisfaction by the fact that the listeners could listen to several community hospitals both in the form of listening to live lectures and listening through the mobile system. The scoring systems of satisfaction from the 20 lecturers is 4.14 (+/- 0.36) from a full 5 points. The listeners' satisfaction was found to be satisfactory in the form of listening to technical knowledge by teleconference.When the rating is 5, all 147 listeners estimated that the average total score is 3.85(+/- 0.15) Discussion: Most of the listeners were nurses.The medical and nursing students have received more information from listening .Community hospital listeners need to listen to content that can be deployed in the context of the community hospital level, but keep up the modernization of academic content. Internet speed is very necessary for delivering live presentations, as well as live interviews that are usually performed after the lecture. Conclusions: Teleconferencing is a useful way of delivering knowledge to a remote location, without the physical obstacles of formal meetings. Take home message: Telemedicine is one of the most cost-effective and time-saving learning methods.

Keywords: Teleconferencing

10 FP08 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

Impact of increased active learning in medical microbiology teaching on medical student learning outcomes

Korakit Imwattana1, Pattarachai Kiratisin1, Patsharaporn Techasintana2, Popchai Ngamskulrungroj1,* 1Department of Microbiology, 2Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

*Corresponding Author’s E-mail: [email protected]

Abstract

Background: Knowledge in the medical microbiology field is continuously expanding and traditional teaching methods are no longer adequate. Active learning helps to provide a deeper understanding and enables independent learning. This study aims to evaluate the effect of active learning on increasing students’ knowledge, procedural skills, and soft skill outcomes. Methods: We increased the use of active learning in medical microbiology for third-year medical students in 2016. Knowledge, procedural skill, and soft skill outcomes were compared with those of the class of 2015. Knowledge was assessed by a summative MCQ examination. Procedural skill was assessed by Gram stain examination. Soft skill outcomes were assessed by peer- and self-evaluation questionnaires. Results: Approximately 300 students per year were included in this study. Active learning hours were increased from 52.96% to 71.43% of the total teaching hours of approximately 140 hours. Multidisciplinary teaching hours were also increased from 6.3% to 30.71%. Students in the active learning class had lower summative scores in the basic knowledge part (67.13% vs 75.43 %; p value < 0.001). However, the adjusted scores of the active learning class was marginally, but statistically insignificantly, higher in the application of knowledge part , eventually, caught up with the traditional class in clinical approaches for infectious diseases (67.30% vs 62.50%; p value = 0.070). The active learning class had lower procedural skills scores (77.57% vs 82.44; p value < 0.001). For soft skill outcomes, the active learning class had more improvements in most evaluated soft skill outcomes (p value < 0.05). Conclusions: The results showed improved both academic and performance by students with increased active learning hours. This suggests that careful design of active learning is needed to maximize the efficacy of such teaching methods.

Keywords: Medical education, Active learning, Knowledge, Procedural skill, 21st century skills

11 FP09 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

Underestimation of learning outcome achievement of students by traditional two-step thinking single-best answer-multiple choice question: A study in a medical microbiology course of preclinical year medical students Popchai Ngamskulrungroj1,*, Yodying Dangprapai2, Sansanee Senawong3, Patompong Ungprasert4, Azian Harun5 1Departments of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand 2Departments of Physiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand 3Departments of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand 4Clinical Epidemiology Unit, Department of Research and development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand 5Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia

*Corresponding Author’s E-mail: [email protected]

Abstract

Single best answer multiple-choice question (SBA-MCQ) has been effectively used to test higher order cognitive process in clinical years of medical curriculum. However, to use SBA-MCQ to test higher-order cognitive process in preclinical years, simultaneous assessment of two learning outcomes at the same time is often required. Therefore, it is difficult to pinpoint which learning outcome has been achieved. The current study was conducted with the aims to investigate if two-step thinking SBA-MCQs underestimate, overestimate or accurately estimate the learning outcome achievement of students. This study was done during the 2017 basic microbiology course of the 3rd year medical students (n=316) of the faculty of Medicine Siriraj Hospital, Mahidol University, Thailand. The test was presented in a four-option SBA-MCQ format but instead of assessing more than one learning outcome at the same time with just one SBA-MCQ, the test consisted of sequential sets of SBA-MCQs that assessed only one learning outcome for each question with the first question (Q1) asking about the causative agent of a specific infectious disease (major outcome 1 – MjO1), the second question (Q2) asking about the characteristics of the microorganism of Q1 (major outcome 2 – MjO2), and the third question (Q3) asking about pathogenic mechanisms of that microorganism (minor outcome – MnO). We created imitated (i) SBA-MCQ score by using the score of Q2 (iSBA-MCQ1; tested for MiO1 and MjO2 simultaneously) and Q3 (iSBA-MCQ2; tested for MiO1 and MnO simultaneously). The scores (in percentage) of iSBA-MCQ1 and iSBA-MCQ2 were then compared with the scores (in percentage) of Q1 (MjO1), Q2 (MjO2) and Q3 (MnO). The scores of Q2 and Q3 were adjusted first to truly reflect the achievement of students (scores were given only if their answers of Q2 and Q3 were correctly correlated with their answers of Q1). The mean of the sum of scores of Q1 and adjusted scores of Q2 (in percentage) was 90.9% (standard deviation [SD] 9.9%) whereas the mean of scores of iSBA-MCQ1 (in percentage) was 85.9% (SD 14.0%) which was significantly lower (p < 0.001). The mean of the sum of scores of Q1 and adjusted scores of Q3 (in percentage) was 87.4% (SD 9.8%) whereas the mean of scores of iSBA-MCQ2 (in percentage) was 81.5% (SD 13.2%) which was significantly lower (p < 0.001). Moreover, analysis of the performance of individual student found that the sum of scores of Q1 and adjusted scores of Q2 was higher than iSBA-MCQ1 in the 65.8% of students whereas the sum of scores of Q1 and adjusted scores of Q3 was higher than iSBA-MCQ2 in the 87.8% of students. The results of the current study may suggest that the interpretation of scores of two-step thinking SBA- MCQs needs to be done with caution as they often underestimate the knowledge and achievement of students.

12 FP10 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

THE MEDICAL STUDENTS PERSPECTIVE FOR EARLY EXPERIMENTAL CLINICAL EXPOSURE IN PRECLINICAL YEAR INSTRUCTION PROGRAM

Nicharee Mungklang1, Atcha Pongpitakdamrong1, Wutthipong Sriratthanarak1, Seekaow Churprung2, Pimphaka Phaderm3, Areerat Siripongpan4, Naporn Uengarporn1

1School of Pediatrics, Institute of Medicine, Suranaree University of Technology 2School of Family and Community Medicine, Institute of Medicine, Suranaree University of Technology 3Institute of Medicine, Suranaree University of Technology 4School of Psychiatry, Institute of Medicine, Suranaree University of Technology

Corresponding Author’s E-mail: [email protected]

Abstract

Background: Early clinical exposure program was use as medical curriculum, Suranaree University of Technology since 2007. Today, medical students are learning introduced to patient contact, communication skills and clinical examination in the preclinical years with the purpose of recognition of clinical experience. Objective Assess and analyses climate perspective of preclinical students to the Experimental Based Learning and early clinical exposure. Methods: The third year medical students were enrolled in ‘Behavior and Development of Human’ course for 1 weeks. Questionnaire for all students after the team work strategy with 4 students in each group to practice in child growth and development to use in “Well Child Care Clinic” at the primary care clinic in the community under role model teachers and supervisors. Pre- and post-program outcomes were analyses by percent change and pair sample t-test. Results: Data from 79 students completed the questionnaire in June 2016. Differences in perspective between pre and post self-assessment scores of student’s 11 course learning outcomes(CLOs) in cognitive (3CLOs), critical thinking (2CLOs), attitude (4CLOs), and skills (2CLOs) areas were overall increasing 32.89%(p<0.05). The significant change in attitude, skill, and cognitive areas in growth and development assessment were 36.71%, 35.32% and 34.56%, respectively (p<0.05). The overall satisfaction in the activities was 4.23 from 5. Conclusion: Experience Based Learning by integrating knowledge and clinical practice was good in perspective of preclinical year medical students in ‘Behavior and Development of Human’ subject. Continuing the program is recommended for the preclinical year medical students.

Keywords: Experimental Clinical Exposure, perspective, preclinical year

13 FP11 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

Correlation between Kolb’s Learning Styles (KLS), GPAX and VARK Learning Styles in Pre-clinical Medical Students

Paween Tangchitphisut, M.D.

Department of Orthopaedics, School of Medicine, Mae Fah Luang University, Thailand

*Corresponding author: [email protected], +(66)854426463

Abstract

Background: Learning styles is the key factor indicating the achievement of student’s learning. It gives them more responsibility for their learning especially a sense of ownership and engagement in the learning process. This study is to find out the relationship among Kolb’s learning styles (KLS), VARK learning styles and GPAX of students. Methodology: This study included the 2nd and 3rd year medical students of the School of Medicine, Mae Fah Luang University during the academic year of 2018 (N=64, n=32/year). The data used Kolb’s learning styles (KLS) questionnaire (Thai language version) and VARK learning style questionnaire. Correlation between students’ KLS, GPAX and VARK Learning Styles were analyzed Results: 64 participants (22 males) participated in the study. Main areas of KLS and VARK learning styles were reflector and kinesthetic styles (59.38% and 28.13%, respectively). No correlation between both types of learning styles with GPAX but found correlation between KLS and VARK learning styles (p- value=0.04). The significant correlations indicated between activist and visual styles (p-value=0.04), activist and kinesthetic styles (p-value<0.01), reflector and auditory styles (p-value=0.02), theorist and auditory styles (p-value<0.01), and theorist and kinesthetic styles (p-value<0.02). Discussion and conclusion: KLS and VARK learning styles didn’t relate with GPAX but KLS related with VARK learning styles. This could assume that teachers settled class’ environment and teaching methods that match up the students’ learning styles. Also, students realized their styles and used their strong point to achieve success of their study.

Keywords: Correlation, Kolb, VARK, Learning styles, GPAX

14 FP12 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

Active learning in perspective of pre-clinical medical student

Chaiyapun Lertpheantum1*, Sirachat Nitchaphanit 1,2 1 Mr.(Phramongkutklao College of medicine, 317/5 Ratchavithi road Ratchathewi district Bangkok, 10400, Thailand), 2 Lt.(Microbiology, Phramongkutklao College of medicine, , 317/5 Ratchavithi road Ratchathewi district Bangkok, 10400, Thailand)

*Corresponding Author’s E-mail: [email protected]

Abstract

Active learning can enhance achievement of medical student learning while the curriculum is designed by teacher perspective. This research focused on the factor improve the learner achievement based-on learner’s perspective in active learning pattern consist of Problem-based learning (PBL), Team-based learning (TBL) and case-discussion. Exploratory sequential mixed method design was performed on 197 medical students by focus-group discussion and questionnaire for evaluate student’s perspectives in 5 factors including lecturer, learning-activity, instruments, learner and environment. This study used exploratory factor analysis (EFA) and one-way ANOVA for compare each score between active learning’s pattern. The developed questionnaire has qualified reliability (0.916). From EFA the highest factors loading is participation of learner (PBL=0.792, TBL=0.833, and case- discussion=0.894). In contrast, the lowest factors loading is lecturer graduated in MD degree except case discussion (PBL=0.316 and TBL=0.356). From ANOVA found equal learner’s perspective in pattern of active learning. Learner’s participation is the most important factor in their perspective because they can show their idea to the group. After the session, lecturer will give feedback to the learner and correct the misunderstanding idea. This will improve learning achievement in active learning. Small group discussion can enhance the achievement of learner because learner can communicate to each other easier. As case-discussion is more clinically applied than PBL and TBL so lecturer with MD degree is more required, while in TBL and PBL lecturer should have a good role of facilitator but is not necessary to graduate from MD degree.

Keywords: Active learning, Student’s perspective, curriculum

15 FP13 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

An Innovative Learning Method by Modified Thailand’s TV Game-show in Pre-clinical Medical Education, Mae Fah Luang University: Pilot Study.

Paween Tangchitphisut, M.D.

Department of Orthopaedics, School of Medicine, Mae Fah Luang University, Thailand

*Corresponding author: [email protected], +(66)854426463

Abstract

Background: A Proper learning environment is one factor that might increase medical students’ learning capability. Our study used modified and integrated medical knowledge games called “Game Zone” and “Flash Quiz”, the two most popular of Thailand’s Game-shows, as learning media for our medical students Methodology: Our study divided 3rd year medical students of Mae Fah Luang University into 4 groups (n=8/group) based on Kolb’s Learning Styles (KLS). The modified game-show based learning method was orientated and assigned to read before starting the game. The “Flash Quiz” based game was aimed to teach “Fat Embolism and Venous Thromboembolism”. The “Game Zone” based game was aimed to teach “Spot diagnosis in Gastrointestinal microbiology”. The group’s score, course satisfaction and participants’ reflections were collected and analyzed. The course satisfaction on Game-show based learning was compared with the conventional courses. Results: 32 participants (10 males) participated in the games. The 3rd Group (combined all types of the KLS) had higher scores than other groups (13 points). Game–show based learning showed significantly higher satisfaction scores than the conventional course (overall average score=4.87±0.01 and 4.48±0.22, respectively; p-value<0.01). The satisfaction score on teachers was 4.88±0.14 points. Most of participants’ reflections were “Fun”, “Known knowledge” and “Creativity”. Discussion and conclusion: The modified Thailand’s game-show based learning was an innovation for applying medical knowledge into the game and creating the proper learning environment with the theme “Happy to Learn, Learn with Happiness” for our medical students.

Keywords: Innovation, Medical education, Game-show, Learning style, Medical student

16 FP14 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

The Effects of Jasmine Oil inhalation on stress in preclinical male medical students At Mae Fah Luang University

Songphop Thubnin, Jittanan Apisitamornkul, Phannitar Pramojanee, and Supapich Jitmun

School of Medicine, Mae Fah Luang University

E-mail: [email protected]

Abstract

Background : People nowadays; especially, medical students are always facing stress resulting from hard studying. The purpose of this research is to study the effect of essential jasmine oil on stress. Objective : To examine the effects of the aroma of essential jasmine oil having an Influence in decreasing stress of male medical students in preclinical course at Mae Fah Luang University and to examine an approach to the development of using essential jasmine oil in decreasing stress. Design : An experimental study. Setting : School of Medicine, Mae Fah Luang University, Chiangrai, Thailand. Materials & Methods : The study population consisted of 20 male medical students from pre- clinical course at Mae Fah Luang University by using Non-randomized controlled trials. The participants were in a small group classroom, and the 10 ml. of 2% essential jasmine oil was provided to sniff for 20 minutes. To evaluate the result, self-assessment and self-analysis stress questionnaires of the department of mental health, ministry of public health were used to assess the stress level. Results : The total scores of the average of the stress level between after studying and after testing are different in terms of statistical significance (p- value< 0.01). Therefore, this shows that essential jasmine oil can decrease the stress level of male students. Conclusions : The essential jasmine oil can decrease the stress level of male students.

Keywords : Jasmine, Essential oil, Aromatherapy, Stress, Medical students

17 FP16 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

TRAINING THE PHYSICAL MEDICINE AND REHABILITATION RESIDENTS AS A TEACHING ASSISTANT FOR MEDICAL STUDENTS.

Sumalee Suethanapornkul*, Arunya Suppuang

Department of Rehabilitation Medicine, Phramongkutklao College of Medicine.317 Ratchawithi road, Ratchathewi ,10400 Bangkok, Thailand

*Corresponding Author’s E-mail: [email protected] Abstract

Rehabilitation medicine is included in the curriculum according to the criteria set by the Medical Council of Thailand. In the Phramongkutklao College of Medicine, Rehabilitation Medicine rotation is in the 5th year medical students for a period of 3 weeks. The purpose is to provide medical students with knowledge in rehabilitation medicine at the general medical practice level as prescribed by the Medical Council of Thailand. Focus on practice, clinical skills and self-study. One of the main objectives in the Physical Medicine and Rehabilitation (PMR) residency training, department of Rehabilitation Medicine Phramongkutklao Hospital is being a teaching assistant to medical students. To standardize the teaching process, the faculties has developed “the Training for Trainer Program” and the Manual of Teaching - Assistant. Department of Rehabilitation Medicine, Phramongkutklao College of Medicine has given importance and assigned the PMR residents as a teaching assistant. The emphasis is on teaching skills in the field of rehabilitation medicine for example the use of walking aid, postural drainage and breathing exercises, bed positioning to prevent pressure ulcers in paralyzed patients. Objective: To develop the PMR residents as a teaching assistance with standardized teaching skill and contents. Methods: The faculties design of teaching subjects and evaluation forms as the following; Define the topic of the skills needed in rehabilitation medicine. Each instructor develops a guideline for the practice of each topic, covering the objectives, content and methods of learning, measurement and evaluation format. These are published in the Manual of Teaching - Assistant. Schedule a day for teaching and preparing the PMR residents. Set the medical student’s teaching schedule by PMR residents and observe the first teaching session by the faculties or senior residents. Evaluate or assessment medical students either at the end of teaching or by the OSCE. Ask the medical students to evaluate the teaching skill of the PMR residents by questionnaire at the end of the course. Results: The PMR residents improve communication skills and engage with medical students.96.75% of medical students are very satisfied with the PMR residents as a teaching assistant. The medical examiner's performance (OSCE) was very good. The PMR residents can be an assessor the clinical skills test of medical students. Conclusion: The training for trainer program at department of Rehabilitation Medicine Phramongkutklao Hospital has benefits and improves the learning process and outcome.

Key word: Teaching assistant, standardize

18 FP17 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

Medical student perception in different types of formative evaluation score feedback

Chadakan Yan, MD, Daranee Intralawan, MD, Kannikar Saisawat, MD, Piti Phloenchaiwanit, MD

Medical education center Chiang Rai Prachanukroh Hospital, ChiangRai, Thailand

*Corresponding Author’s E-mail: [email protected]

Abstract

Background: Student’s examination score will be ranked and shown in public,which increases stress among medical students.This study aims to assess the student perception of different methods of giving formative evaluation score feedback. Summary of Work:: Seventy clinical-year medical students completed an online anonymous survey about three scoring feedback methods including Confidential- individual score(A),Confidential-individual score with class-ranking(B) and Non-confidential score(C) feedback.Feedback stress and motivation were identified using Likert scales.Additionally,Focus-group interview was performed in ten medical students to identify perception,self-esteem, stress,and motivation of medical students toward each method. Summary of Results: The percentage of students who prefer feedback A, B, C method was 15.7%, 77.1%, and 7.2%, respectively.The data showed average-GPA(2.50-3.00) students tend to have higher stress from feedback,but they also have higher learning motivation.While below-average-GPA students(<2.50) were likely to have less stress and motivation.Focus group interview showed that learning goals and score expectation has correlated with their stress.Moreover,they preferred to know their individual overall performance and pitfalls rather than the scores. Discussion: Method B was favored because the students preferred to keep their score secret,but still want to compare their learning performance with classsmates.Increase in learning motivation is potential benefits from medthod B.We should pay more attention to below-average-GPA students who have less learning motivation from all feedback methods. Conclusion: Method B should be done to reflect clinical knowledge.Furthermore, giving feedback needs instructor-student interaction.Feedback on student performance is more important than examination score.The instructors need to adjust their teaching to support and enhance student learning. Take-home messages: Learning- performance feedback is important to medical students. Teacher-student participation is a key to success.

Key word: Formative assessment, score feedback

19 FP21 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

TRANSITION FROM PAPER-BASED TO ELECTRONIC PORTFOLIO USING ON-HAND SOCIAL MEDIAS FOR MEDICAL STUDENTS

Chalinee Monsereenusorn1, Piya Rujkijyanont1, Chanchai Traivaree1 and Sangkae Chamnanvanakij2

1Division of Hematology-Oncology, Department of Pediatrics, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi Rd, Khwaeng Thung Phaya Thai, Khet Ratchathewi 10400, Bangkok, THAILAND 2Head, Department of Pediatrics, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi Rd, Khwaeng Thung Phaya Thai, Khet Ratchathewi 10400, Bangkok, THAILAND

*Corresponding Author’s E-mail: [email protected]

Abstract

Background: The academic portfolio has become a key to evaluate ethics and professionalism for health professions. Motivation is the major role to drive medical student to create and realize meaningful portfolio. On-hand technologies and social media become a vital part of life in this century. Integration of technologies and social media into electronic portfolio aims to motivate student in creating prosperity portfolio with satisfaction and user friendly. Methods: Transition from paper-based into electronic portfolio by combining with Google® form to submit and compile documents in a single place with Line® application to communicate between students and teachers was initiated. Feedback from teacher was submitted by email directly to student and administrator. We conduct a study to evaluate students’satisfaction by using a questionnaire focusing in 4 domains to compare between paper-based and electronic portfolio: easy and less complex to fill up; fast and convenient; beneficial for longitudinal follow-up and easy archiving. A Likert scale from 0 to 5 was used to define levels of disagree to totally agree. Results: 98 of the 4th year medical students returned the questionnaire (100% response rate). Students preferred electronic to paper-based portfolio (83.7% vs 16.3%) in 4 domains; fast and convenience (3.10 vs 2.17, p<0.001), benefit for longitudinal follow-up (3.00 vs 2.21, p<0.001) and easy archiving (2.61 vs 2.29, p=0.002). However, there was no difference in the score of ease and complexity to fill up between the two groups. Conclusion: Medical students preferred electronic to paper-based portfolio. Electronic portfolio should be implemented to improve the quality of portfolio in undergraduate level.

Keywords: electronic portfolio, Google® form, Line®, satisfaction

20 FP22 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

Factors affecting decision to study in Master degree of Medical Technologist

Kunahip Suthhiyuth and Phachadapan Odompet

Faculty of Medicine Siriraj Hospital Mahidol University

Email: [email protected]

Abstract

The study Factors affecting decision to study in Master degree of Medical Technologist. The purpose study factors affecting decision to study in Master degree of Medical Technologist. The study is quantitative method. The sample consisted of 937 undergraduate medical technicians from Bangkok University and 240 medical technicians. The data analysis is correlation statistic of data ; sex, education level of parents, provincial workplace, income level , field of work, and Factors affecting decision to study in Master degree of data ; curriculum , facility support, location , public relations, and staff. The research found that; the data is correlated. The benefits of research. To improve the curriculum of Master of Science Clinical Laboratory Sciences Faculty of Medicine, Siriraj Hospital To be known and interested in studying more.

21 FP23 การประชุมวิชาการแพทยศาสตร์ศึกษาแห่งประเทศไทย ครั้งที่ 19 19-21 ธันวานคม 2561 ณ มหาวิทยาลัยแม่ฟ้าหลวง ภายใต้หัวข้อ “Leadership Towards Medical Education Excellence”

การศึกษาปัจจัยที่ส่งผลต่อการเลือกศึกษาต่อในระดับปริญญาโทของนักเทคนิคการแพทย์

นายคุณาธิป สุทธิยุทธ์ และ นางสาวพัชดาพรรณ อุดมเพ็ชร

Faculty of Medicine Siriraj Hospital Mahidol University

Email: [email protected]

บทคัดย่อ

การศึกษาเรื่องปัจจัยที่ส่งผลต่อการเลือกศึกษาต่อในระดับปริญญาโทของนักเทคนิคการแพทย์ วัตถุประสงค์ของงานวิจัย เพื่อศึกษาปัจจัยที่มีความสัมพันธ์กับการเลือกเรียนในระดับปริญญาโทของนักเทคนิค การแพทย์ ซึ่งเป็นการวิจัยเชิงปริมาณ กลุ่มตัวอย่างของการวิจัยเป็นนักศึกษาระดับปริญญาตรีคณะเทคนิค การแพทย์ของมหาวิทยาลัยในเขตกรุงเทพฯ 937 คน และ นักเทคนิคการแพทย์ 240 คน ในการวิเคราะห์ ข้อมูลใช้การหาความสัมพันธ์ของข้อมูล ได้แก่ ระดับการศึกษา เพศ ระดับการศึกษาของผู้ปกครอง ระดับ รายได้ จังหวัดที่ปฏิบัติงาน สายงานที่ก าลังปฏิบัติงาน กับ ปัจจัยบางประการที่ส่งผลต่อการตัดสินใจเลือกเรียน ในระดับปริญญาโทของนักเทคนิคการแพทย์ ในด้านหลักสูตร ด้านราคา ด้านสิ่งสนับสนุน ด้านสถานที่และ ที่ตั้ง ด้านช่องทางการประชาสัมพันธ์ ด้านบุคลากร ผลการวิจัยพบว่า ข้อมูลมีความสัมพันธ์กัน ประโยชน์จาก ผลงานวิจัย เพื่อน ามาปรับปรุงหลักสูตรวิทยาศาสตรมหาบัณฑิต สาขาวิชาวิทยาศาสตร์ห้องปฏิบัติการคลินิก คณะแพทยศาสตร์ศิริราชพยาบาล ให้เป็นที่รู้จักและมีผู้สนใจเข้าศึกษามากยิ่งขึ้น

22 FP23 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

COMPARATIVE STUDY OF LEARNING OUTCOMES ON SAFETY BLOOD TRANSFUSION USING IN-CLASS DIDACTIC VERSUS MULTIMEDIA-BASED TEACHING IN SIXTH YEAR MEDICAL STUDENT AT PHRAMONGKUTKLAO HOSPITAL AND COLLEGE OF MEDICINE

Piya Rujkijyanont1*, Chalinee Monsereenusorn1, Chanchai Traivaree1 and Sangkae Chamnanvanakij2

1 Division of Hematology-Oncology, Department of Pediatrics, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi Rd, Khwaeng Thung Phaya Thai, Khet Ratchathewi 10400, Bangkok, THAILAND 2 Head, Department of Pediatrics, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi Rd, Khwaeng Thung Phaya Thai, Khet Ratchathewi 10400, Bangkok, THAILAND

*Corresponding Author’s E-mail: [email protected]

Abstract

Background: Blood transfusion is life-saving procedures in various medical circumstances. Blood banking processes are well-organized and extremely safe in this era. However, transfusion-related complications are still reported and most of them are clerical errors from healthcare providers. Objective: To investigate the most effective method to deliver a “safety transfusion” message to medical students in order to strengthen their competency in blood transfusion and minimize transfusion- related complications. Methods: One-hundred of the 6th year medical students participated in this study during their pediatric rotations. “Blood transfusion safety” lesson was delivered to students using 2 different techniques. In order to prevent unintentional disclosure of multimedia contents, the first 51 students from first 4 pediatric rotations were selected to attend in-class didactic; whereas, 49 from the rest of following rotations were introduced to our new multimedia-based teaching. Learning outcomes were measured using pre- and post-multiple-choice questions (MCQs) and Mini-clinical evaluation exercise (Mini-CEX) assessment in hematology clinic. Results: Among 100 medical students participated in this study, students who attended in-class didactic had significantly higher differences in pre- and post-MCQ percentages (40.78±19.98) compared to those who underwent multimedia-based teaching (28.00±23.21) with a p-value of 0.004. However, students who underwent multimedia-based teaching had significantly higher percentages of Mini-CEX assessment (98.72±4.81) compared to those who attended in-class didactic (79.92±14.63) with a p-value of <0.001. More interestingly, students who underwent multimedia-based teaching also achieved higher percentages in pediatric summative examination (69.57±6.98) compared to those who attended in-class didactic (63.46±7.92) with a p- value of <0.001. Conclusion: Multimedia-based teaching is superior to in-class didactic in training students to transfuse blood safely in real clinical setting. Moreover, multimedia-based teaching might be a new teaching intervention for successful academic achievement.

Keywords: blood transfusion safety, multimedia-based teaching, in-class didactic, Mini-CE

23 FP24 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

Stress and Socio-demographic Factors Related to Empathy among Medical Students in Faculty of Medicine Vajira Hospital

Nitchawan Kerdcharoen MD1* Jiratchaya Jakeepaiboon2, Duanghatai Roeklaksanee2, Benjarat Kirdthongtawee2, Pimpitcha Mapuloh2, Wilasinee Moolsilp2, and Apisara Sanguanklin2

1 Department of Psychiatry, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand 2 Medical student, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand

*Corresponding Author’s E-mail: [email protected]

Abstract

The objectives of this study were to study empathy score stress and socio-demographic factors related to empathy among medical students. The study was a descriptive cross - sectional study was conducted in 255 first to sixth year medical students at the Faculty of Medicine, Vajira Hospital. The instruments were composed of socio-demographic factors questionnaires, Perceived Stress Scale-10 (PSS-10) and Jefferson Scale of Physician Empathy-Student Version (JSPE-S) in Thai language. Statistical analysis included descriptive analysis, unpaired t-test, Mann-Whitney test, ANOVA, Kruskal- Wallis test, Pearson’s correlation, Spearman’s rank correlation, Point-biserial correlation, Eta correlation and multiple linear regression. The results showed that the participants were 255 medical students, male 51.4% and female 48.6%. The mean empathy scores measured by JSPE-S Thai version is 107.80 (S.D.=12.4). The mean of PSS-10 Thai version score is 15.1 (S.D.=5.9). There were no statistically significant difference in empathy scores between subgroup of socio-demographic factors and level of stress. The analysis shown that the department is currently studying (r = 0.149), students' socioeconomic status (r = 0.132), effective medical role models (r = 0.0.045), personal counselors (r = 0.005) and stress (r = 0.141) had positively correlation with empathy scores statistically significant. In the regression model, higher socioeconomic status (β = 0.645, p = 0.037), students' mental problems (β = -0.281, p = 0.027) as well as stressors (β = 0.186, p = 0.038) had effect on empathy score. In conclusion, medical education should implement the importance of medical role model, learn how to live a sufficiency economy and mental health promotion to enhance the level of empathy in medical students. Keywords: empathy, stress, medical student

24 FP26 การประชุมวิชาการแพทยศาสตร์ศึกษาแห่งประเทศไทย ครั้งที่ 19 19-21 ธันวานคม 2561 ณ มหาวิทยาลัยแม่ฟ้าหลวง ภายใต้หัวข้อ “Leadership Towards Medical Education Excellence”

ความเครียดและปัจจัยด้านสังคมประชากรที่สัมพันธ์กับการร่วมรู้สึกต่อผู้ป่วยในนักศึกษาแพทย์ คณะแพทยศาสตร์วชิรพยาบาล

นิจวรรณ เกิดเจริญ พ.บ., วว.จิตเวชศาสตร์1*, จิรัชญา จาคีไพบูลย์2, ดวงหทัย ฤกษ์ลักษณี2, เบญจรัตน์2 เกิดทองทวี2, พิมพ์พิชชา มะปูเลาะ2, วิลาสินี มูลศิลป์2, อภิสรา สงวนกลิ่น2

1 ภาควิชาจิตเวชศาสตร์ คณะแพทยศาสตร์วชิรพยาบาล มหาวิทยาลัยนวมินทราธิราช กรุงเทพมหานคร ประเทศไทย, 2 นักศึกษาแพทย์ คณะแพทยศาสตร์วชิรพยาบาล มหาวิทยาลัยนวมินทราธิราช กรุงเทพมหานคร ประเทศไทย

E-mail ของผู้ประสานงาน: [email protected]

บทคัดย่อ

การศึกษานี้เป็นการศึกษาคะแนนการร่วมรู้สึกต่อผู้ป่วย ปัจจัยด้านความเครียดและสังคมประชากรที่สัมพันธ์กับการ ร่วมรู้สึกต่อผู้ป่วยในนักศึกษาแพทย์ โดยเป็นการศึกษาเชิงพรรณนาแบบตัดขวาง ท าการศึกษาในนักศึกษาแพทย์ชั้นปีที่1-6ของ คณะแพทยศาสตร์วชิรพยาบาล 255 คน โดยใช้แบบสอบถามประกอบด้วย แบบสอบถามปัจจัยด้านสังคมประชากร แบบวัด ความรู้สึกเครียด(Perceived Stress Scale-10, PSS-10) แบบวัดการร่วมรู้สึก Jefferson Scale of Physician Empathy- Student Version (JSPE-S) ฉบับภาษาไทย วิเคราะห์ข้อมูลโดยใช้สถิติเชิงพรรณนา, unpaired t-test, Mann-Whitney test, ANOVA, Kruskal- Wallis test, Pearson’s correlation, Spearman’s rank correlation, Point-biserial correlation, Eta correlation และ multiple linear regression จากผลการศึกษากลุ่มตัวอย่างนักศึกษาแพทย์จานวน 255 คน เป็นเพศ ชายร้อยละ 51.4 เพศหญิงร้อยละ 48.6 ค่าคะแนนเฉลี่ยการร่วมรู้สึกต่อผู้ป่วยจากแบบวัดการร่วมรู้สึกJSPE-Sฉบับภาษาไทย เท่ากับ 107.8 (S.D.=12.4) คะแนนความเครียดเฉลี่ยจากแบบวัดความรู้สึกเครียด PSS-10 เท่ากับ 15.1 (S.D.=5.9) เมื่อ เปรียบเทียบหาความแตกต่างของระดับคะแนนการร่วมรู้สึกในแต่ละปัจจัยด้านสังคมประชากรและความเครียดพบว่าไม่ แตกต่างกัน ปัจจัยที่มีความสัมพันธ์ทางบวกกับการร่วมรู้สึกต่อผู้ป่วยอย่างมีนัยส าคัญทางสถิติที่ระดับ 0.05 ได้แก่ ภาควิชาที่ ก าลังศึกษาอยู่ (r = 0.149) สถานภาพทางเศรษฐกิจ (r = 0.132) การมีแบบอย่างการเป็นแพทย์ที่ดี (r = 0.0.045) การมีที่ ปรึกษาเมื่อประสบปัญหา (r = 0.005) และคะแนนความเครียด (r = 0.141) ปัจจัยที่มีอิทธิพลต่อระดับการร่วมรู้สึกต่อผู้ป่วย อย่างมีนัยส าคัญทางสถิติได้แก่ สถานภาพทางเศรษฐกิจ (β = 0.645, p = 0.037) ปัญหาหรือโรคทางจิต (β = -0.281, p = 0.027) และความเครียด (β = 0.186, p = 0.038) ซึ่งสรุปได้ว่าการศึกษาในหลักสูตรแพทยศาสตร์ควรมีการจัดรูปแบบ การศึกษาที่เน้นความส าคัญของบุคคลต้นแบบ (role model) สอนแนวทางการด าเนินชีวิตแบบเศรษฐกิจแบบพอเพียง ส่งเสริม ป้องกันและช่วยเหลือปัญหาด้านสุขภาพจิตเพื่อสร้างเสริมระดับการร่วมรู้สึกต่อผู้ป่วยในนักศึกษาแพทย์ ค าส าคัญ: การร่วมรู้สึกต่อผู้ป่วย, ความเครียด, นักศึกษาแพทย์

25 FP26 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

THE BMBOC-GAMIFICATION AS AN INNOVATIVE TOOL OF MEDICAL EDUCATION IN PHRAMONGKUTKLAO COLLEGE OF MEDICINE

Thanakrit Vichasilp*, Montalee Theeraapisakkun, Charin Cheungsirakulvit, Nattaprapa Suriyamontol, Prakarn Rudeekulthamrong, Unchalee Visawapoka, and Alisa Sanamontre

Department of Biochemistry, Phramongkutklao College of Medicine, 317 Ratchawithi Road, Thung Phaya Thai, Ratchathewi District, 10400, Bangkok, Thailand

*Corresponding Author’s E-mail: [email protected]

Abstract

Successfully integrating e-learning into traditional classroom is a major challenge for medical education because engagement in online programs is difficult to maintain. We have faced this problem in the Biochemistry and Molecular Biology Online Course (BMBOC) since 2010. Gamification is the recent trend that offers to increase engagement through the application of game elements and gaming techniques to non-game contexts. This study aimed to develop a gamification in the BMBOC and improve student participation and engagement. The BMBOC-gamification is developed using the Moodle software. It allowed students to check their course activities, points, items, and leaderboards. Students earned eXperience Point (XP) from completed activities. There were 51 activities to be completed before receiving the course certificate. All year 2 medical students (N=99) were assigned to attend this course. After the course end, the evaluation data were collected using questionnaires (5-point Likert-type items) and self-reflections (open coding scheme). The survey showed that XP, items, challenge activities and leaderboards are the most important gamification methods (μ ≥ 4.5). The reflection data gathered was examined and classified into 3 categories: fun, gamification, and education. 95% of the students were satisfied with the system as a whole. 91% of them were satisfied that the system enhances student motivation and engagement. 99% of them love the formative assessment part of the system. Moreover, all students believed that the system was a beneficial revision tool to test their learning and less stressful than studying in class, thus they strongly recommended using it in other courses. Keywords: e-learning, gamification, Moodle, engagement

26 FP27 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

BODY PAINTING: A TOOL FOR LEARNING CUTANEOUS NERVE OF LEG IN PRECLINICAL MEDICAL STUDENTS

Malee Chanpoo1*, Manop Chaimati1, Tunyarut Koonchornboon1 and Piyachat Chansela1

1 Department of Anatomy, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand

*Corresponding Author’s E-mail: [email protected]

Abstract

Introduction Normally, the principle method of teaching anatomy is based on lectures and practical laboratory courses using dissection, pro-section and anatomical models. The traditional method of learning surface anatomy on cadavers needs the student to play a lot of attempts in recalling the anatomical landmarks. Previously, the surface anatomy painting has been reported as a powerful tool for engaging learning experience and being beneficial to knowledge retention in medical students. Objectives The objective of this study was to assess the perception of preclinical medical students for learning cutaneous nerve supplying the surface area of the leg by using the body painting. Methods The preclinical medical students were divided into two groups including the traditional learning method and body painting exercise. All of the students needed to complete a pre-test exercise before learning the cutaneous nerve of the leg. After laboratory class, all groups of the students should give the feedback using questionnaire and the retention knowledge of the surface anatomy was examined by a post-test exercise, immediately. Results The quantitative analysis results found that there was no statistically significant difference in knowledge retention between two groups. However, the students agreed that the painting exercise was fun and helpful to encourage the understanding in anatomical contents. Moreover, they also admired the innovative activity for leaning human anatomy. Conclusion The body painting was a useful tool to make learning surface anatomy more fun and increasing the understanding in anatomical contents.

Keywords: Body painting, Anatomy, Cutaneous nerve, Preclinical medical student

27 FP28 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

ADMISSION OF MEDICAL STUDENT IN PHRAMONGKUTKLAO COLLEGE OF MEDICINE THROUGH TCAS

Phunphen Napradit1*, Raweewan Ekgasit2, Kitiporn Putthikhunt2

1 Department of Physiology, Phramongkutklao College of Medicine, Bangkok 10400 Thailand 2 Academic Affairs Division, Phramongkutklao College of Medicine, Bangkok 10400 Thailand

*Corresponding Author’s E-mail: [email protected]

Abstract

Introduction: Student selection and recruitment for Phramongkutklao College of Medicine (PCM) in academic year 2018 was only through the third round (Joint direct admission) of Thai University Central Admission System (TCAS). Admission scores as academic performance were derived from 7 common subjects examination organized by National Institute of Educational Testing Service and specific subject examination conducted by Consortium of Thai Medical School. The objective of this study was to evaluate admission of medical student in PCM through TCAS. Methods: The admission scores and demographic data of medical students who passed admission criteria into PCM were analyzed. Results: The number of students recruited by TCAS 3/1 was 100 and by TCAS 3/2 was 9. At the end of clearing house system, 59 males and 40 females were admitted as PCM’s medical student. Their average age was 17.5 years old. The majority of students came from secondary school located in Bangkok. The mean and SD percentage of total admission scores, 7 common subjects and specific subject were 63.73+3.23, 64.04+4.30 and 62.99+4.40, respectively. Male medical student who got highest admission score (81.45%) recruited from TCAS 3/1. The lowest admission score was 59.44% recruited from TCAS 3/2. Females had scores on specific subject, social, Thai and English language higher than males. Conclusion: TCAS was a major part of admission process on medical education. However, the association between academic performance as admission scores and competency outcomes as medical education goal was unclear. Further study is required to assess the selection and recruitment process in PCM.

Keywords: Admission, Selection and recruitment, TCAS

28 FP29 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

APPLICATIONS ELECTRONIC-IMMEDIATE FEEDBACK ASSESSMENT TECHNIQUE (E-IFAT PS@PCM) PROGRAM INSTEAD OF THE IFAT ANSWER PAPER

Anusara vattanajun, Panadda hatthachote and Sommai yochana

Department of Physiology, Phramongkutklao College of Medicine, Bangkok, Thailand.

Corresponding Author’s E-mail: [email protected]

Abstract

Introduction IFAT is a test-taking technique which students can get the answer instantly whether the answer is right or wrong. The students will stop doing the test when they get the correct answer. It encourages students to learn during the test and recognizes longer. Objective To develop the electronic-immediate feedback assessment technique (e-IFAT PS@PCM) program for the goal of replacing the IFAT answer paper which have restrictions on its use. Methods The e-IFAT PS@PCM program was developed in the same way as the IFAT answer paper except for unlimited number of questions with 4 or 5 answer choices for each. It can display real-time score and score ranking of all student groups both on the smartphone and the tablet computer. The program was tested for ease of use by students in the group readiness assurance test (gRAT) of team-based learning (TBL). Results Not only the students can get immediate feedback after the selection of answers similar to using the IFAT answer paper but also know the scores and ranking while doing the quiz. This encourages students to participate in learning activity even more. Based on the interview and the focus groups, the students were very satisfied because the program is user friendly and shows real-time score ranking of their own compared to other groups. Conclusions The program reduces the restriction as compared to the IFAT answer paper. It allows the instructor to create the test as desired, such as the number of questions or the key assignment of the answer.

Keywords: electronic-Immediate Feedback Assessment Technique program, e-IFAT PS@PCM

29 FP30 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

Quick Response for Evaluation of Clinical Practice in Medical Student

Onrumpa Kanlapakornchai1, Warisa Tanakurutham1, Onanong Noomcharoen1, Supanut Sirikuichayanonta1, Chuenrutai Yeekian2

1 Center of Medical Education, Queen Savang Vadhana Memorial Hospital, 290 Jermjompol road, Sriracha, Chonburi, 20110, Thailand 2 Center for supporting and developing research, Queen Savang Vadhana Memorial Hospital, 290 Jermjompol road, Sriracha, Chonburi, 20110, Thailand

Email: [email protected]

Abstract

One of the most important processes in medical education is a rapid report learning outcomes. The obstetrics and gynecology course have many activities in clinical practice and examination led to use more than sixteen evaluation paper forms. Quick response or QR code is easy to use by smart phones, and the data were immediately sent to be analyzed at that time. G Suite for Education is a cloud- based suite that helps the clerkship to connect and get work done from anywhere on any device. Therefore, the 16 evaluation paper forms of obstetrics and gynecology course were designed in Google forms, and the QR code of each student was done from its URL. When the instructors scan QR code of the student, the processes of evaluation were as follows: 1) Evaluation system shows name and surname of the student for verification. 2) The instructors select type of evaluation forms based on the activity. 3) The instructor provided score of the student and click “sent” button. 4) Data were sent to the clerkship by G Suite for Education. The satisfactions of QR code system were evaluated by the instructed questionnaires to the instructors, staffs, and students. There were 25 persons answer the questionnaires those were 10 instructors, 2 staffs, and 13 medical students. For the 10 instructors, most of them were female (8 out of 10) with age average 38.7 (SD 7.4) years old. The 2 staffs were female, and had age 24, and 34 years old. For the 13 students, they were 21-24 years old, and 54% or 7 from 13 were female. Their opinions about the QR code system were as follows. The average scores of opinions about the QR code system of the instructors, staffs, and medical students were 9.5, 9.0, and 8.7 scores out of 10 scores, respectively. For instructors, the highest score were shown in the topics; decrease volume of using paper (10.0 (SD 0.0) scores), decrease processes of sending the score (9.9 (SD 0.3) scores), can sent the score quickly (9.9 (SD 0.3) scores), respectively. The staffs’ satisfactions were high in topics as follow; easy and convenience to use, receive the score from instructors quickly, documents don’t be lost, and decrease processes of working (all items rate at 9.5 out of 10 scores). For the students, they satisfied in topics that documents don’t be lost, and decrease burden; carrying the documents at all time (rate at 9.2 out of 10 scores).

Keywords: QR code, Evaluation, G Suite for Education

30 FP31 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

LEARNING STYLE PREFERENCES IN 2-YEAR MEDICAL CADETS AND ACADEMIC SCORES OF 4-BLOCK SYSTEMS

Anusara Vattanajun1, Panadda Hatthachote1*

1Department of Physiology, Phramongkutklao College of Medicine, Bangkok, Thailand

*Corresponding author’s E-mail: [email protected]

Abstract

Introduction: Students differ in their learning preferences. It is important for educators to understand their learning styles. Objectives: To investigate learning style preferences of the 2-year medical cadets at Phramongkutklao College of Medicine, academic year 2560 and compared different learning styles with the mean scores of knowledge, skills and total scores derived from the Block CVS and Respiration System, Urinary and Reproductive System, Endocrine System and Medical Neuroscience-1 System which altogether were 13 credits. Methods: Assessment of learning style preferences was carried out using the model adapted from Franklynn Chernin. Their differences were determined by scoring the answer of questions into visual, aural, reading/writing and kinesthetic sensory modalities. The combination scores (mean ± SD) from the 4-Block systems for each modality were conducted. One- way ANOVA was used to evaluate significant score difference for each modality and independent T- test was for comparing scores between uni-modal VS multi-modal. Results: Overall 99 medical students (61 males and 38 females), the majority (77.78%) were uni-modal learners. The kinesthetic was the most common learning style preference (46.46%), followed by visual (18.18%), read/write (11.11%) and aural (2.02%) styles. Among the rest, 19.2 % preferred bi-modal and 3% used tri-modal. Students with multi-modality had high scores of knowledge, skills and total scores than those of uni- modal but, there was no significant difference of scores among the students as well as gender. Conclusions: Different learning style preferences and gender had no effect on the scores in this study however other factors may be involved.

Keywords: Learning styles, score of knowledge

31 FP32 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

Changes in Positive Psychology Attitudes after Watching Movies: A Medical Student Study

Sirinut Siritikul1, Sirikorn Chalanunt1, Chitipat Utrapiromsook1 Suchanard Mungara1, Tinakon Wongpakaran2, Nahathai Wongpakaran2, Danny Wedding3

1Faculty of Medicine, Chiang Mai University, Thailand 2Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Thailand 3Saybrook University, Oakland, California, USA

*Corresponding Author’s E-mail: [email protected]

Abstract

Introduction: Professionalism is required of all physicians, and various activities have been proposed to enhance professionalism in medical students. The aim of this study was to examine how watching films influenced positive psychology character strengths. Methodology: This study used a pretest- posttest design with 40 first-year medical student volunteers. Participants in this three-day activity watched four movies: Twilight, Gandhi, Shawshank Redemption, and Amélie. These films involved themes of Self-regulation, Humility, Prudence, and Gratitude, respectively. We used a 17-item Self- regulation scale, a 12-item Prudence scale, a 15-item Humility scale and a 6-item Gratitude scale. All measures demonstrated acceptable Cronbach’s alpha, ranging from 0.71 to 0.85. All participants completed all questionnaires before and after watching movies. We used paired-sample t-tests to evaluate changes between pre and posttest, and Rasch analysis to qualitatively determine who benefited from the test. Results: The pre- and post-scores were 62.25 (SD7.66) vs 66.00 (SD7.5) for Self- regulation (p = 0.000); 53.90 (SD4.82) vs. 55.60 (4.29) for Humility (p <0.0001); 60.08 (6.9) vs. 65.28 (SD 7.3) for Prudence (p < .0001); and 33.00(4.6) vs. 33.65 (4.7) for Gratitude (P=0.345). Gender was not associated with any of positive psychology scales. Rasch analysis showed the following changes after watching movies: no change 9 (22.5%); improved 19 (47.5%); worsened 12 (30%). Conclusion: Watching films may help foster positive values in medical students. However, students should be carefully evaluated during the viewing process to ensure that change occurs in a positive direction. Selecting appropriate films to support medical student growth is a continuing challenge.

32 FP33 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

EFFECTS OF LEARNING METHODS FOR LECTURE ON ACADEMIC ACHIEVEMENT OF PRECLINICAL MEDICAL STUDENTS

Wasit Wongtrakul1* and Yodying Dangprapai1

1 Undergraduate Education Unit, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Siriraj, Bangkok Noi, Bangkok, 10700

*Corresponding Author’s E-mail: [email protected]

Abstract

Live lectures during preclinical years at the Faculty of Medicine, Siriraj Hospital consist of two methods: traditional and interactive lectures. By permission of instructors, the Undergraduate Education Unit publishes recorded lectures, or e-lectures, via a learning management system entitled Siriraj E- Learning and Education Community (SELEC), to assist students in lesson review. However, an increasing number of students decided to watch only the e-lectures instead of attending the live lectures. This observation has resulted in an anxiety and skepticism among faculty members regarding effectiveness of the e-lectures on student’s learning. Consequently, many instructors decided not to allow the publication of their live lectures via SELEC. Studies from other countries found that learning methods, either attending the live lectures or watching the e-lectures, have no significant effect on academic achievement of medical students. Instead, students’ behaviors during the lectures influenced their examination scores. This case-control study will explore an effect of live lecture attendance on academic achievement of the selected basic science courses. The cases were defined as students with below-average examination scores and the controls as their peer counterparts. The exposure was irregular live lecture attendance. Results from this study may contribute to policy of lecture attendance and e-lecture publication.

Keywords: live lecture, preclinical medical students, examination scores

33 FP34 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

The Development of Communication Skills of First Year Medical Students Through Health Interview Activities

PORNPIMOL PILUNTANAPPORN, KANYIKA CHAMNIPRASAS, KORAMAS SANGUANSAI

Faculty of Medicine: Prince of Songkla University

E-mail : [email protected]

Abstract

The Purpose of this study was to examine the development of the communication skills of medical students through health interview activities, which are part of the languages and communication course, PSU. This course is designed for first year medical students, and first stared in academic year 2018 with 189 students. The Health interviews activities was divided into 3 clusters: community leaders, patients-relatives and the elderly. The study instruments was a 5-level rating scale questionnaire designed to assess students' opinions, with a reliability of 0.76 and a communication skills assessment. Data were analyzed by descriptive statistics for percentage, mean, standard deviation. The results showed that the students have the opinion that health interviewing activities encourage good listening and respect of others are at the highest level and followed by encourage personality skills, communicate with others, human relations interaction, and being a good speaker. Evaluation of communication skills of students by interviewees were 1) human relationship and give Honor to others 99.68% do well. 2) Good personality 99.52% do well. 3) Be a good listener and take into account the feelings of others 99.35% do well. 4) The initiation of interactions 98.18% do well. 5) The enthusiasm and attention to the conversation 97.84% do well 6) Clear communication 96.23% do well and 7) Modesty, courtesy, humility 100% do well. Concluding health interview activities enhance communication skills by learning through direct experience in interacting with others in the context of working as a physician, achieving the objectives of the activity.

Keywords: health interview activities, communication skills, medical students

34 FP36 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

First year medical students’ reflections on community immersion: CPIRD program at Prince of Songkla University

Rasikorn Nookliang1, Arnuparp Lekhakula1, Kanyika Chamniprasas1, Pairoj Boonluksiri2, Koramas Sanguansai1, Nongluk Rukleng1

1Faculty of Medicine, Prince of Songkla University, 2Medical Education Center, Hatyai Hospital, Hatyai, Songkhla, Thailand

E-mail: [email protected]

Abstract

Community Immersion (CI) is a unique, community-based activity that allows for 1st year CPIRD medical students, of PSU, to experience early exposure to rural community environments. Its new learning approach aims to enable students to gain experience through an immersion in a community context, and to additionally enhance positive attitudes, towards doctors working for proactive health care in the future. This study explored students reflections on CI, and analyzed factors which supported the intended learning objectives. A Descriptive study design, utilizing a mixed methods approach. A questionnaire, with 5-point Likert scale, in 3 aspects; (1) community attractiveness (2) better understanding of communities and families (3) involvement in community health care, with a reliability of 0.93. Qualitative data was collected on students’ reflective portfolios, from CI-1st to 3rd visits, to ascertain the students intended competencies. The data were analyzed by using descriptive statistics and content analysis. Factor analysis was used to examine the inter-item correlations, with a reliability of 0.78. Overall, fifty-eight CPIRD students, in the academic year of 2017, participated in the activities (response rate 83% and 100% for portfolio). The results revealed that: the students appreciated the opportunity of gaining early experiences in a community setting, and displayed positive attitudes (95%), provided a deeper understanding of the social and culture context (88%) and strengthened the students’ ability to work with other professionals (85%). The analysis of reflective portfolios elaborated that CI enhances development of professional attitudes, and learning motivation through early exposure in rural community health care.

Keywords: community immersion, community-based, health care

35 FP37 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

A Generalizability Theory Approach to Estimate Generalizability and Dependability Coefficients of the Assessment from Multiple Perspectives for Innovative Media to Promote Health Awareness.

ANUPONG KANTIWONG

Department of Pharmacology, Phramongkutklao College of Medicine

E-mail: [email protected]

Abstract

Introduction: In the course of Pharmacology, third-year medical students are encouraged to create innovative media to promote health awareness about rational drug use. The purposes of this study was to determine the reliability of multiple-perspective assessment across different source of raters (instructors, representative students and audiences) by using G-theory. Methods: 100 students are divided into 10 groups to create a short-communication video. The G-study with a fully crossed one-facet design (Group X Rater) quantifies the amount of variance and G-coefficient. The D-study provides information about the optimal number of raters in different sources needed to obtain reliable measurements. Results and discussion: G-study shows the G-coefficients of assessing by single instructor, representative student or audience were 0.75,0.54 and 0.66, respectively and D-study suggested that dependability level of 0.85 can be achieved by using two instructors, five students or three audiences for a one-time assessment. Although instructor had the highest D-coefficient and increasing the number is efficient in increasing reliability score, but evaluation from multiple sources will contribute to the diverse perspectives in terms of utilization. Conclusions: This study demonstrated that all source of raters in multiple perspectives assessment have high reliability score and suggested that greater improvements in dependability might be made by increasing the number of instructor rather than by increasing the number of representative students or audiences.

36 FP38 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

TEST-ENHANCED CASE-BASED LEARNING: A RANDOMIZED TRIAL

Siriporn Thitisagulwong MD 1*, Cherdsak Iramaneerat MD, PhD 2, Tripop Lertbannapong MD 3

1 Master of Science Program in Health Science Education, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd., Bangkoknoi Bangkok 10700 Thailand. 2Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd. Bangkoknoi Bangkok 10700 Thailand. 3Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd. Bangkoknoi Bangkok 10700 Thailand.

Corresponding Author’s E-mail: [email protected]

Abstract

Introduction: There was a lack of evidence to support the use of test-enhanced case-based learning to promote clinical reasoning skills of medical students. Objectives: To compare the effectiveness of test- enhanced case- based learning with case- based learning alone in undergraduate medical students. Methods: Fifty- eight 4th year medical students, who attended the Department of Obstetrics & Gynecology between June – September 2018, were randomly allocated into two groups: ( 1) the intervention group, received test-enhanced case-based learning, and (2) the control group, received case-based learning alone. Pretest scores was recorded as base line score of each student. After finished teaching session over a 3-day period, students completed the assessment of clinical reasoning (posttest) with 4 modified essay questions. Results: The two groups had similar means and standard deviations of pretest scores. ( t ( 56) = . 417, p = . 678) Means and standard deviations of posttest scores in intervention group is higher than the control group, but was not statistical different. (t (56) = -1.143, p = .26). When sub-group analysis was performed, the test-enhanced case-based learning showed significant benefit over case-based learning without test in students with low pretest scores and in posttest I (threatened abortion). Conclusion: Test-enhanced case-based learning is a powerful learning tool for the special group of the students with appropriate topic and proper level of difficulty of the tests.

Keyword: test-enhanced learning, casr-based learning, clinical reasoning

37 FP39 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

STRUCTURED REFLECTIVE WRITING TO INCREASE CONFIDENCE LEVELS IN EMERGENCY OBSTETRIC ANESTHESIA OF NURSE ANESTHETIST STUDENTS

Patcha Hortrakul, Sahatsa Mandee, and Kasana Raksamani

Master of Science Program in Health Science Education Faculty of Medicine Siriraj Hospital, Department of Anesthesiology Faculty of Medicine Siriraj Hospital, Mahidol University 10700

*Corresponding Author’s E-mail: [email protected]

Abstract

The purpose of this experimental study was to compare the confidence level after went through the learning methods the structured reflective writing and the structured feedback for the improvement of confidence level to the application of normal descriptive reflective writing and the general feedback among 36 nurse anesthetic students (NAS) of Siriraj Hospital, who were the targeted and sampled population by matching-sampling in emergency obstetric anesthesia. The NAS received the 2 types of reflection and feedback following a scenario- based, hands- on workshop in general anesthesia for emergency obstetrics, with the comparison of confidence level before the workshop, immediately after the workshop, and after having completed 2 cases of general anesthesia. All students completed the confidence tests and reflective writing reports. The repeat measured data analysis consisted of frequency, percentage, mean, standard deviation, paired t-test, and ANOVA. There were the changed scores between the 2nd and the 3rd confidence tests after the increased scores of the 1st confidence test for each question, but not significantly different between the groups in all questions. The writing reports of reflection demonstrated that the structured reflective questions could guide the participants to succeed in the depth of reflection more than the non-structured reflective questions.

Keywords: Structured reflective writing, Reflection, Structured feedback

38 FP40 การประชุมวิชาการแพทยศาสตร์ศึกษาแห่งประเทศไทย ครั้งที่ 19 19-21 ธันวาคม 2561 ณ มหาวิทยาลัยแม่ฟ้าหลวง ภายใต้หัวข้อ “Leadership Towards Medical Education Excellence”

การเขียนสะท้อนคิดแบบมีโครงสร้างเพื่อเพิ่มระดับความมั่นใจในการระงับความรู้สึกผู้ป่วยฉุกเฉิน ทางสูติกรรมให้นักศึกษาวิสัญญีพยาบาล

พัชชา ห่อตระกูล, สหัสา หมั่นดี, และ กษณา รักษมณี

การศึกษาวิทยาศาสตร์สุขภาพ วิทยาศาสตร์มหาบัณฑิต คณะแพทยศาสตรศิริราชพยาบาล, ภาควิชาวิสัญญีวิทยา คณะแพทยศาสตร์ศิริราชพยาบาล มหาวิทยาลัยมหิดล10700

E-mail ของผู้ประสานงาน: [email protected]

บทคัดย่อ

การศึกษานี้มีวัตถุประสงค์เพื่อศึกษาว่าการเขียนสะท้อนคิดและให้ข้อมูลย้อนกลับแบบมีโครงสร้างจะช่วยเพิ่มระดับความมั่นใจ ของนักศึกษาวิสัญญีพยาบาลในการดูแลผู้ป่วยฉุกเฉินทางสูติกรรมมากกว่าการเขียนการสะท้อนคิดและให้ข้อมูลย้อนกลับแบบ ไม่มีโครงสร้างหรือไม่ ด้วยการวิเคราะห์ระดับความมั่นใจของนักศึกษาวิสัญญีพยาบาลหลังจากมีการเขียนสะท้อนคิดและให้ ข้อมูลย้อนกลับ 2 ประเภท เปรียบเทียบก่อนและหลังเข้าร่วมการเข้าฝึกปฏิบัติในสถานการณ์จาลองเรื่องการระงับความรู้สึก ผู้ป่วยฉุกเฉินทางสูติกรรม และหลังจากการระงับความรู้สึกผู้ป่วยฉุกเฉินทางสูติกรรม โดยจัดผู้เข้าร่วมการวิจัยจานวน 36 คน จากนักศึกษาวิสัญญีพยาบาลเป็น 2 กลุ่ม กลุ่มแรกได้รับแนวค าถามเพื่อการสะท้อนคิดและให้ข้อมูลย้อนกลับแบบไม่มี โครงสร้าง กลุ่มที่สองได้รับการเขียนสะท้อนคิดและให้ข้อมูลย้อนกลับแบบมีโครงสร้าง ทั้งสองกลุ่มได้ท าแบบสอบถามระดับ ความมั่นใจคนละ 3 ครั้ง และท าการสะท้อนคิดและได้รับข้อมูลป้อนกลับทั้งหมดคนละ 3 ครั้ง ข้อมูลที่ได้จะถูกวิเคราะห์และ น ามาสรุปผลในภาพรวมของกลุ่ม ในรูปแบบของ ความถี่, ร้อยละ, ค่าเฉลี่ย, SD.} paired t-test, anova repeated measure และ content analysis ผลการศึกษาพบว่าการระดับความมั่นใจของทั้งสองกลุ่มไม่พบความแตกต่างกันอย่างมีนัยส าคัญทาง สถิติ แต่การเขียนสะท้อนคิดและให้ข้อมูลย้อนกลับแบบมีโครงสร้างส่งเสริมให้สามารถสะท้อนคิดได้ระดับลึกมากกว่าการ สะท้อนคิดและให้ข้อมูลย้อนกลับแบบไม่มีโครงสร้าง

ค าส าคัญ: การเขียนสะท้อนคิดแบบมีโครงสร้าง, การสะท้อนคิด

40 FP40 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

THE SATISFACTION OF USING MOODLE FOR STUDYING INFECTIOUS DISEASES AND IMMUNOLOGY (MICROBIOLOGY PART).

Nitchatorn Sungsirin 11* and Veerachai Watanaveeradej 21

1 Department of Microbiology, Phramongkutklao College of Medicine, 315 Tungpayathai, Rachatewi, Bangkok, 10400, Thailand

*Corresponding Author’s E-mail: [email protected]

Abstract

The objective of this research is to study the satisfaction of Moodle as an online Learning Management System (LMS). The study group, selected by purposive sampling, was 100 Phramongkutklao College of Medicine cadets who had been studying Infectious diseases and Immunology (Microbiology part) in the first semester of the academic year 2017. The research instruments were Moodle satisfaction questionnaires in Google form. Statistical tests employed to the satisfaction consisted of percentage, mean, standard deviation and relation analysis. All of them were analysed by SPSS (22.0). From the questionnaires found that 56% of these medical cadets were male. Satisfaction on Moodle was reported in VERY GOOD ranks for all questions including ‘overview of using Moodle as online LMS’, ‘suitable platform design’, ‘support understanding in leaning lessons’, ‘activate learners for participation’, ‘facilitate for work submission’ and ‘need to continue using’. Relation analysis showed that there was no relationship between the gender and the satisfaction for all questions. Factors that influence significantly (P < 0.05) on need to continue using Moodle were support understanding in leaning lessons and activate learners for participation.

Keywords: Learning management system, Moodle, Google form, Infectious diseases and Immunology, satisfaction.

39 FP41 การประชุมวิชาการแพทยศาสตร์ศึกษาแห่งประเทศไทย ครั้งที่ 19 19-21 ธันวานคม 2561 ณ มหาวิทยาลัยแม่ฟ้าหลวง ภายใต้หัวข้อ “Leadership Towards Medical Education Excellence”

ความพึงพอใจตอการใชบทเรียนคอมพิวเตอรชวยสอนประกอบการเรียนวิชาโรคติดเชื้อและภูมิคุ้มกัน วิทยา (ในส่วนของจุลชีววิทยา)

นิจธร สังข์ศิรินทร์1*, วีระชัย วัฒนวีรเดช1

1 ภาควิชาจุลชีววิทยา วิทยาลัยแพทยศาสตร์พระมงกุฎเกล้า,

E-mail ของผู้ประสานงาน: [email protected]

บทคัดย่อ

การวิจัยเรื่องนี้มีวัตถุประสงค์เพื่อศึกษาความพึงพอใจของนักเรียนแพทย์ทหาร วิทยาลัยแพทยศาสตร์พระมงกุฎเกล้า ต่อการใช้งานระบบการจัดการเรียนการสอนด้วย Moodle โดยวิธีการวิจัยเชิงสํารวจจากนักเรียนแพทย์ที่เรียนในวิชาโรคติด เชื้อและภูมิคุ้มกันวิทยา (ในส่วนของจุลชีววิทยา) ในภาคการศึกษาที่ 1/2560 จํานวน 100 นาย เครื่องมือที่ใช้ในการรวบรวม ข้อมูลคือแบบสอบถามออนไลน์ใน Google form สถิติที่ใช้ในการวิเคราะห์ข้อมูลคือ ค่าร้อยละ ค่าเฉลี่ย ส่วนเบี่ยงเบน มาตรฐาน และการวิเคราะห์ความสัมพันธ์ด้วยโปรแกรม SPSS 22.0. พบว่าผู้ทําแบบสอบถามเป็นเพศชาย ร้อยละ 56 ผลการ วิเคราะห์แบบสอบถามความพึงพอใจของผู้เรียนต่อระบบการจัดการเรียนการสอนออนไลน์ Moodle พบว่า ผู้เรียนมีระดับ ความพึงพอใจในทุกข้อคําถามในระดับดีมาก ทั้งภาพรวมของระบบการจัดการเรียนการสอนออนไลน์ Moodle มีรูปแบบที่ เหมาะสม ส่งเสริมการเรียนรู้ให้เข้าใจในบทเรียนมากขึ้น กระตุ้นให้ผู้เรียนมีส่วนร่วมในกระบวนการเรียนการสอน อํานวยความ สะดวกในการมอบหมายงานและการส่งงาน และผู้เรียนมีความต้องการให้ใช้ Moodle ต่อไป ผลการวิเคราะห์ความสัมพันธ์ พบว่า เพศของผู้เรียนไม่มีผลต่อระดับความพึงพอใจ ปัจจัยที่มีอิทธิพลอย่างมีนัยสําคัญ (P<0.05) ต่อความต้องการให้มีการใช้ งานระบบการจัดการเรียนการสอนออนไลน์ Moodle ต่อไป คือ การส่งเสริมการเรียนรู้ให้เข้าใจในบทเรียนมากขึ้นและกระตุ้น ให้ผู้เรียนมีส่วนร่วมในกระบวนการเรียนการสอน

ค าส าคัญ: Learning management system, Moodle, Google form, Infectious diseases and Immunology, satisfaction.

40 FP41 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

Frontiers of Learning in Internal Medicine in 21st Century

Col. Ouppatham Supasyndh, M.D.

Department of Internal Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand

*Corresponding Author’s E-mail: [email protected]

Abstract

Department of internal medicine, Phramongkutklao hospital was founded in 1934. The process of teaching and learning was developed through the years and transformed from direct teaching to interactive learning. Nowadays, the evolution of teaching and learning through technology integration is superficial at all levels of education. Technology and education have been taken together, which has changed the classroom as well as the roles of the instructors and students. In this 21st century, department of internal medicine is being reformed to the edge of teaching and learning style by renovates the old-fashioned classroom to modern-style electronic smart classroom using wireless interactive white board interface with personnel tablet computers and tracking the teaching process during the class. Web-based application will be launched this year to help both instructors and students accessing the class schedules and ward clerkship. On-line evaluation and feedback system are also applied in the app. We create e-learning by using MOOCs or massive open online courses to engage students in self direct learning. Mock electronic examination is undergoing trials to proof the beneficial effect of learning. Three years of mentor system will help student to develop both mindful and knowledge to reach the goal of learning in internal medicine. Finally, we realize in social responsibility. Hence, environment protection, human resources and customers engagement are also in our strategy. In summary, world’s technology is sky rocket growth. Teaching and learning should be followed the way of the world. Acknowledgement: Faculty staffs of the department of internal medicine, Phramongkutklao college of medicine

41 FP42 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

OBJECTIVELY-DEFINED, FACILITATOR-GUIDED CASE DISCUSSION: A TOOL TO PROMOTE LEARNING AND CULTIVATING 21st CENTURY SKILLS

Chitrawina Mahagita1, 2*,and Panadda Hattachote 1

1 Physiology Department, 2 Medical Education Unit, Phramongkutklao College of Medicine, 317 Ratchavithee Road, Ratchatavee, 10400, Bangkok, Thailand

*Corresponding Author’s E-mail: [email protected]

Abstract

New curriculum of Phramongkutklao College of Medicine (PCM) has been changed to organ system-based in academic year 2016. It incorporates both horizontal and vertical integration. Besides, medical students are cultivated for 21st century skills. Therefore, Physiology Department of PCM has developed objectively-defined, facilitator-guided case discussion (OFCD) for 2nd-year medical students. Chronic kidney disease (CKD) is selected for Urinary and Reproductive Systems Block. This study aims to report medical students’ perspective on OFCD. Block committee set 10 learning-objective questions of CKD. Each objective has advisor. Ninety-nine medical students were divided into 10 groups. Each group did all 5 questions and met advisors twice. First was to clarify tasks. Then, students self-studied and prepared group presentation. Second meeting was to rehearse with advisors. Students were reminded for 5-min-presentation/question. Presentation day, teacher drew by lots for each question presentation. Post-test and focus-group interview were done. Questionnaire and written reflection were applied at end of block. This design was well accepted by medical students. Focus group revealed that students realized application of basic knowledge. Preparing all 10 questions/group encouraged participation from every member. Satisfaction of OFCD was 4.47  0.06 from 5. From reflection, OFCD was major theme of transformative learning. Learning and innovative skills were enhanced through communication and collaboration, and problem solving. Information and media literacy were promoted for skills of information, media and technology. Lastly, life and career skills were facilitated in flexibility and adaptability. Hence, OFCD is one of effective tools to promote knowledge integration and 21st century skills.

Keywords: case discussion, 21st century skills, active learning

42 FP43 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

Affecting Factors for Retention in Health System of New Doctors from Suranaree University of Technology.

Seekaow Churproong1*, Naporn Uengarporn2

1 Family and Community Medicine, Institute of Medicine, Suranaree University of Technology

E-mail: [email protected]

Abstract

Background: New doctors tend to increase of resignation from Ministry of Public health. However, the medical curriculum at Suranaree University of Technology (SUT) is posted regarding happy doctor in the community. Therefore, the percentage of new doctors at SUT should be a high retention number in the Public health system. Objectives: This study reports the affecting factors of new doctors from SUT that retain in the health system and evaluates the survival rate of retention in the first year of working. Methods: Cohort study was used in this study. 43 (100%) new doctors who graduated in 2015 from SUT responded the questions by phone in 2 times at post-graduate and 6 months later, including the individual, social, and environmental factors were questioned. Multiple logistic regression and Survival analysis were used in this study. Findings: 41(95.34%) new doctors worked at the public hospital. There was only 2(4.7%) doctors resigned from the system in order to study in the specific education. No factors significantly related to the retention in the health system. Gender, city of hometown, and study program were analyzed by Kaplan-Meier. Finally, these factors were not significantly affected the retention in the health system, using the Log-rank test. Conclusion: A small sample size in this study might be a limitation for analysis. Therefore, a high number of sample size should be accumulated in the further year for decreasing the limitation.

Keywords: new doctor, survival rate, the retention, Suranaree University of Technology

43 FP44 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

Comparison of Grade Point Average and the Pass of Medical License Examination in the Pre-Clinical Medical Students.

Kwanruan Pinwanna1*, Noknoi Sripho,2, and Sarawut Suksuphew 3

1 Institute of Medicine, Suranaree University of Technology, Nakhon Ratchasima, Thailand.

E-mail: [email protected]

Abstract

Background: This research aims to study the comparison of grade point average (GPA) and the pass of medical license examination (Step-I) in the pre-clinical medical students of Institute of medicine, Suranaree University of Technology. Methods: This was the retrospective study. The participants were medical students who studied in the year of 2012-2015. The data was the cumulative GPA at the end of the 3rd academic year and the first pass of the medical license examination exam (Step-I). The statistical analysis was done by using independent paired sample t-test. Results: The participants were fifty-seven, seventy-nine, seventy-nine and eighty students in the year of 2012-2015, respectively. The group of medical students who passed the medical license examination had higher GPA than those who did not pass with statistically significant (p <0.05) in every academic year. Conclusions: The medical students with higher GPA level at the end of the 3rd academic year will have the opportunity to pass the medical license examination in step-I.

Keywords: Grade point average, medical license examination, preclinical medical students

44 FP45 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

Evidence-based medicine: A survey among 5th year medical students of Suranaree University of Technology.

Kanala Chanvirat 1*, Fuangfa Kongngern2, Parichad Saewong3, and Pakwimon Subhaluksuksakorn4

1 Family and Community Medicine, Institute of Medicine, Suranaree University of Technology

E-mail: [email protected]

Abstract

Introduction: Evidence-based medicine (EBM) were taught to 3rd year medical students at Suranaree University of Technology (SUT). However, we are concerned that there might be variations in applying EBM in clinical practice. This study aims to assess the current practice of EBM during the clinical years among 5th year medical students at SUT. Methods: A cross-sectional descriptive study was conducted during September, 2018. All 5th year medical students were asked to answer an online questionnaire. The studied variables were five-steps of EBM practice (asking a question and PICO formulation, access and searching, critical appraisal of the evidence, application to patients, and assessing EBM performance) and their use in the clinical year, as well as promoting factors for and barriers to EBM practice. Descriptive statistics were used to describe the practice pattern/promoting factors/barriers to practice of EBM among 5th year medical students. Results: Out of 80 students, 77 (96.2%) responded to the online questionnaire. Of the 5 Steps, they frequently practiced access and searching for evidence (20.8%). However, the other 4 steps were rarely practiced. To find the best evidence they used Up-to-date and PUBMED more frequently than other databases. The primary factor that promoted EBM practice was strong assignments from the staffs (61.0%). The barriers to EBM practice were difficulty in accessing the best articles (36.4%) and the lack of skills for appraising scientific articles as well as reading English in a limited time (32.5%). Conclusion: Our findings revealed a low level of EBM practice from the fundamental five steps. In order to encourage implementation of EBM in the clinical years, there should be focus on available scientific database resources as well as improvement of the students’ skills to access and appraise the scientific literature.

Keywords: Evidence-based medicine, 5th year medical students, clinical year

45 FP46 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

AN ETHICAL CHALLENGE FOR THE STUDENTS OF MEDICINE: COERCION IN PSYCHIATRIC INPATIENT TREATMENT.

Fabio Calzolari

School of Social Innovation, Mae Fah Luang University

[email protected]

Abstract

Object. Coercion, as the use of physical or psychological force to make a person accept a treatment that has been refused, is a widespread practice within psychiatric settings. Many people believe it to be unethical because it violates patient’s autonomy. Some would argue that it is an example of paternalism. Yet others point to certain medical situations in which the severity of ailments precludes other options. Furthermore, on this sensitive but rarely studied issue, variations across countries reveals differences not only in social attitudes but also in legal traditions. To better understand the phenomenon and its implications on the physician-patient relationship, the research analyzed the narrative data of 20 individuals with a DSM-5 diagnosis Schizophrenia, who were compelled to undergo involuntary treatment in the Republic of Italy. Findings. Patients perceived that co-operation with medical staff was inadequate and their opinions and concerns were not taken into consideration. Even if it was understood that Schizophrenia undermines agency, treatments was seen as too invasive. Secluded and/or restrained patients gave an overall negative value to quality of life (QOL). Conclusion. Delineating the boundaries between coercion and persuasion is very difficult if not impossible. It is true that the relationship physician-patient is often unbalanced and destructive. However, the just-let-the- patient-decide approach is also fertile ground of problems, especially when serious mental disorders alter the perception of reality. A medium way can be found through rapid clinical and risk assessment, the deployment of evidence-based and assertive community treatment (ACT) that could increase the likelihood of voluntary admissions. To improve satisfaction with care, students of medicine should devote time to advocate for patient knowledge and empowerment. Low-cost implementable schemes as such as courses on patient’s rights are easily attainable.

Keywords: Coercion, Education, Psychiatry, Schizophrenia

46 FP47 ผลงานวชิ าการ (Proceeding) The 19th Thai Medical Education Conference December 19-21, 2018 at Mae Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

TRAINING PHYSICIANS TO DELIVER BAD NEWS USING PEER ROLE PLAY COMPARED TO STANDARDIZED PATIENTS

Kamoltip Lertchaisataporn MD 1*, Cherdsak Iramaneerat MD, PhD 2, and Supot Pongprasobchai MD 3

1Master of Science Program in Health Science Education, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd. Bangkoknoi Bangkok 10700 Thailand. 2Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd. Bangkoknoi Bangkok 10700 Thailand. 3Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd. Bangkoknoi Bangkok 10700 Thailand.

*Corresponding Author’s E-mail: [email protected]

ABSTRACT Introduction: There is a lack of studies comparing the effectiveness of using standardized patients (SP) and peer role-playing (PRP) for training breaking bad news (BBN). Objectives: To investigate the effectiveness of training physicians to BBN using PRP compared to SP and to examine the participants’ perspectives on their satisfaction and the perceived effect of training. Methods: Thirty-four physicians were assigned into two groups receiving BBN training with PRP or SP in a one-day workshop. The communication skills were evaluated using the Gap–Kalamazoo Communication Skills Assessment Form with one SP encounter at the pre-workshop and two SP encounters at the post-workshop. The questionnaires inquired about the participants’ perspectives on their satisfaction. Results: For PRP group, the posttest scores were significantly higher (35.7 ± 1.75) than for the pretest (27.4 ± 1.99), p < 0.001. For SP group, the posttest scores (36.7 ± 2.78) were also higher than for the pretest (29.2 ± 2.36), p < 0.001. The increased scores were not significantly different for the PRP group (8.28 ± 2.17) and the SP group (7.51 ± 3.52), p = 0.45. The participant’s perspectives on the satisfaction and the perceived effect of communication training showed no significant difference in both groups. Conclusion: The physicians practiced using either PRP or SP, could yield a significant improvement in BBN skills. There was no statistically significant difference between the use of PRP and SP. Both methods seemed comparable for the BBN skill training and were very well accepted.

Keywords: doctor-patient communication, peer role-play, standardized patients, breaking bad news, communication skills training.

1. INTRODUCTION strategies for teaching BBN recommended more faculty- Good communication skills are important for intensive educational interventions in delivering bad news physicians. In particular, effective communication (e.g., role play with feedback, clinical teaching).(6) between physicians and patients can potentially lead to Effective method of teaching communication more accomplishment of health outcomes, better skills should take the form of a practical approach such as compliance, and higher satisfaction.(1-4) Breaking bad PRP or SP. Both methods can promote learning in news (BBN) is one of the most challenging situations for communication. SP is one of the popular teaching methods physicians since they are always involved in delivering for the training of communication skills. This could be a bad news, such as diagnosis, treatment outcome, and real patient or an actor trained to play the patient role as a prognosis, to patients and relatives. Physicians need to be way to teach effective communication skills. There are careful while delivering bad news to their patients since it many advantages to use SP in the training. The use of SP involves emotions and feelings of recipients. is beneficial for both teaching and assessing Communication skills for BBN need to be taught communication skills.(7,8) Applying SP in training requires and practiced in medical professions with several ways more demanding scenarios and emotional safety.(9) SP can and methods. The commonly applied methods include also provide feedback to learners.(7) However, the main didactic, video demonstrations, small group discussion, limitation of using SP is its high cost.(10) Additionally, it role modeling, demonstration, real patients, peer role play takes time for SP to understand the role. (PRP), and standardized patient (SP).(5,6) A review of

47 FP04 The 19th Thai Medical Education Conference December 19-21, 2018 at Mae Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

PRP is another effective method to teach the participated in intervention sessions. Then, there were one communication skills. In this method, medical students physician drop outs in both PRP and SP groups because switch their roles in acting as a doctor and a patient. There they could not completed the posttest assessment. Finally, are many advantages of role play; for example, use of less 34 physicians completed the follow-up assessment, of resources, ease to practice in real world communication whom 17 were in the PRP group and 17 were in the SP training, provision of an opportunity for rehearsal, and group. support to an empathic approach with patients’ The key steps of this study were described as the concerns.(11) However, the limitation of this method is that following. First, I assessed the participants’ BBN skills students may be unrealistic or some of them may feel with using an individual SP encounter at 1 week prior to uncomfortable to play a role with friends. Moreover, the the training. Personal and professional characteristics of training with PRP requires a careful planning, with participants were obtained. Second, I used stratified experienced facilitators, realistic roles, and appropriate randomization of participants after the sampling tasks for the learner’s level and feedback.(12) professional characteristics and the baseline Lane and colleagues reviewed the use of PRP and communication skill performance measurement. The SP in the training of communication skills.(13) This review participants were stratified by their working experiences emphasized a lack of well-designed studies by comparing and the baseline communication skill performance. They the effectiveness of teaching communication skills with were allocated to either the PRP or the SP groups by using PRP and SP. In a recent study of the cost-effectiveness, the random data option in the SPSS program. Third, all Bosse reported a major advantage from the cost- participants attended the session on “Principles of effectiveness analysis of PRP as compared to SP.(9) Both Communication and BBN” and “BBN and SPIKES teaching methods could yield the comparable protocol” (Interactive lecture for the whole group). Fourth, effectiveness and results similar to post training all participants were divided into two groups practiced competence.(14-16) To date, there are scarce studies to BBN using either PRP or SP (Intervention sessions). compare the effectiveness of BBN training with PRP and These sessions were set in parallel sessions in order to SP. Both RP and SP can be important tools for training prevent the contamination between the studies groups. communication skills. Therefore, there is still a gap in the Fifth, for the PRP group, the participants were allocated literature review of the best method to teach BBN. into four small groups. Each group comprised with five physicians. In the first training case of BBN, one of the 2. OBJECTIVES OF THE STUDY group members was assigned to play in the physician’s The purposes of this study were to investigate the role and one for the patient’s role. The physicians, who effectiveness of training physicians to deliver bad news received the patient role, took time to review the script for using PRP compared to SP and to examine the the patient. Then, the facilitators briefed the training cases. participants’ satisfaction and the perceived effect of Next, the participants in the physician role conducted a training. twenty-minute interview for each case. The rests of the group were observers. Each group discussion of how 3. METHODS doctors delivered bad news and how these interviews could be improved. Follow with the discussion within the 3.1 Research Participants and Procedures large group and repeat of role play with roles exchanged This study was a randomized pretest - posttest in the second training case. Sixth, for the SP group, the control group study. The participants were physicians participants were divided into four small groups. Each working at Chulabhorn Hospital and attended the one-day group consisted of five physicians and two SPs. One communicating bad news training program on February participant played the doctor’s role deliver bad news to 22, 2018. The participation in this study was voluntary. one SP for twenty-minute interview for each case. The All participants provided their written consent to rests of the group were observers. Each group discussion participate in this study, with acceptance to use the data in of how doctors delivered bad news and how these this study for research purposes and permission for video- interviews could be improved. Follow with the discussion recording in the SP encounter sessions. This study was within the large group and repeat of role play with roles approved by Siriraj Institutional Review Board and exchanged in the second training case. Then, all Human Research Ethics Committee, Chulabhorn participants attended the session on “Advanced care Research Institute. planning” and “End-of-life discussion” (Interactive Fifty-two physicians participated in this study, of lecture for the whole group). whom 26 were randomized to the PRP group and 26 were After the training, all participants filled in the randomized to the SP group. All participants completed questionnaires to assess their ratings for the satisfaction the baseline assessment of communication skills. There and the perceived effects of the training. Two weeks after were eight physicians drop outs in both PRP and SP the training program, all participants were assessed for the groups before attended intervention sessions. The reasons BBN skills with two individual SP encounters, as well as for not attending were being unable to attend the workshop the collection of their skillful communication during office hours and too busy. Therefore, 36 physicians performance, the perspectives on their satisfaction, and the

48 FP04 The 19th Thai Medical Education Conference December 19-21, 2018 at Mae Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence” perceived effects of the training between the two study sessions in order to prevent the contamination between the groups. studies groups. The two parallel sessions were taught by invited 3.2 The Training Program and Intervention speakers and were designed so that they contained a Sessions similar proportion of speakers and facilitators and training cases - the training cases including discussion and role- 3.2.1 Principle of communication session plays carried out in small groups. The intervention session (Interactive lecture for the whole group) took two hours for practicing BBN with two training A one-day training program was for the BBN cases. training. The program started with an overview lecture on To begin with the PRP group, each small group the principle of communication. This session lasted one comprised with five physicians. One of the group hour. All participants in both PRP and SP groups attended members was assigned to play in the physician’s role and this teaching session. The teaching method was interactive one for the patient’s role. The rest of the members in each lecture. The learning objective for this session was an group were the observers. The physicians, who received introduction to basic of communication skills and the patient role, took time to review the script for the counseling skills. patient. Then, the facilitators briefed the training cases. Next, the participants in the physician role conducted a 3.2.2 Principle of BBN and SPIKES protocol twenty-minute interview for each case. The rests of the session (Interactive lecture and VDO group were observers. Each group discussion of how demonstration for the whole group) doctors delivered bad news and how these interviews This session was the second session of the could be improved. Follow with the discussion within the workshop in the morning which lasted 45 minutes. All large group and repeat of role play with roles exchanged participants in both PRP and SP groups attended this in the second training case. Discussion of the role plays teaching session. The teaching methods were interactive took place both within the small groups and in the large lecture and VDO demonstration. The learning objective group. Finally, the facilitator gave the concluded for this session was an introduction to principle of BBN feedbacks, followed by the group discussion and and SPIKES protocol. The SPIKES protocol, an approach debriefing. for delivering bad news to cancer patients, developed by For the SP arm, each small group consisted of Baile, Buckman and colleagues.(17) The goal of the five physicians and two SPs. One participant playing the SPIKES protocol was to help the doctors while breaking doctor deliver bad news to one SP, the rest observing, bad news to their patients: This protocol can be followed by discussion within the group and repeat of role summarized using the SPIKES mnemonic as:(1) setup; (2) play with roles exchanged. The rests of the group were perception; (3) invitation; (4) knowledge; (5) empathize; observers. Each group discussion of how doctors and (6) summarize and strategize.(17) delivered bad news and how these interviews could be The SPIKES protocol consisted of the following improved. Follow with the discussion within the large six steps.(17) First, the physicians should set up the group and repeat of role play with roles exchanged in the situations which appropriate for BBN. Second, they second training case. Discussion of the role plays took should elicit the patient’s perception of his or her problem. place both within the small groups and in the large group. Third, they should find out how much information the Finally, the facilitator gave the concluded feedbacks, patient wants and invite bad news. Fourth, they should followed by the group discussion and debriefing. provide knowledge and information to the patient. Fifth, they use empathic response to the patient’s emotions. 3.2.4 Advanced care planning and the end-of- Lastly, they could summarize the clinical information and life discussion (Didactics and discussion in a full make a plan for the next step. The SPIKES protocol was group) applicable to teaching BBN in this study. Although the advanced care planning and the end-of-life discussion were not under the scope of this 3.2.3 Workshop of BBN with PRP or SP study, both topics were useful for the participants. These (Intervention session) sessions were conducted by using the didactics method as The teaching methods were role plays to practice well as a discussion with the whole group. The advanced BBN skills with using PRP and SP. The learning objective care planning session lasted 75 minutes. Moreover, the for this session was to practice BBN with using the end-of-life discussion session lasted 90 minutes in the SPIKES protocol with PRP or SP. After the speakers teach afternoon. The learning objectives for these sessions were an overview of the principle of communication and the overview the advanced care planning and the end-of-life concepts of delivering bad news, all participants were discussion. assigned into two groups practiced BBN using either PRP or SP. These sessions lasted two hours for practicing BBN 3.3 Case Scenarios with two training cases. These sessions were set in parallel Five case scenarios (2 training cases, 1 pretest case and 2 posttest cases) were used in this study. The

49 FP04 The 19th Thai Medical Education Conference December 19-21, 2018 at Mae Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence” scopes of 5 cases were the disclosure of bad news with a 3.7 The Participant Perspective Assessment focus on a new diagnosis and recurrence of cancer to SPs. on Satisfaction and Perceived Effect of The emotional responses of SP encounters were sad, silent, angry and denial emotional responses. The reason Communication Training This study used the questionnaires which adapted for choosing these emotional responses for the SP (21) encounters in this study because these responses were from the questionnaires in the study of Bosse. The commonly found in medical practice of delivering bad questionnaires inquired the participant’s perspectives on news to cancer patients. Doctors should identify and the training with using 5-point Likert scale on 1) the address emotional responses.(18) Four experts assessed the satisfaction on the training; (1 = very poor to 5 = very contents of the case scenarios, instructions, scripts for SP, good), and the perceived effects of the training; 2) the and provided their suggestions for each document. The training was worthwhile for time spent; (1 = don’t agree feedbacks from the experts were used to the revision at all to 5 = totally agree), 3) the training was useful; (1 = process of all documents. don’t agree at all to 5 = totally agree), and 4) the training was applicable for future BBN; (1 = don’t agree at all to 5 3.4 Communication Skill Assessment and = totally agree). Post Training Assessment 3.8 Raters and Rater Training This study used one SP encounter for the baseline The raters were comprised with two clinical and two SP encounters for the evaluation of post instructors and one specialist physicians. All of them were intervention. After the workshop, the participants filled in active in the fields of internal medicine and family questionnaires to assess their ratings for the satisfaction medicine. Moreover, they had experiences in BBN and and the perceived effects of the training. took care of cancer patients for eight to fifteen years. 3.5 The SP Encounter Sessions This study used a frame-of-reference training (FORT) for rater training. The FORT focuses on Although the well-constructed OSCE format developing a mutual understanding or frame of reference with 14–18 stations of 5–10 minute duration of each amongst raters.(22,23) The processes of FORT in this study station provided the good reliability.(19) However, there started by having all raters studied the detailed of each were some challenges for the organization of OSCE in this item in the GKCSAF and how to use the GKCSAF. A study; namely, time consumption and man-power trainer defined the dimensions to be evaluated, providing limitations. Therefore, the assessment of the SP encounter and describing appropriate behavioral examples of the for communication skills was necessary in this study. This dimensions to be evaluated. Next, raters were asked to study used one SP encounter for the baseline and two SP view three videos of SP encounters which three physicians encounters for the evaluation of post intervention. The BBN to SPs with poor, average, and excellent cases were written in a way to guide the SPs to play their performances. Raters spent about one hour studying these roles. The SP encounters focused on the delivering of bad videos and practiced scoring on these videos without news to the cancer patients. The objective of SP making spontaneous comments. Then, they discussed encounters was formative in purpose. The observation their markings. The trainer indicated the target rating for time for each encounter was 10 minutes. In each station, each performance dimension. The trainer also pointed out one SP portrayed one role. The physician–patient specific behaviors that led to each particular rating. The interactions were video-recorded after the participants raters could ask if they had any questions. After discuss provided their written consents. Each video-recorded SP for the first practice video, the protocol was repeated for encounter was rated by three independent raters. The the second and third practice videos. Raters and trainer raters were blinded to the group allocation. discussed their markings and reach a consensus. The goal 3.6 The Gap-Kalamazoo Communication was to calibrate the raters’ opinions and enable discussion Skill Assessment Form (GKCSAF) about the performance scoring. In this study, I used the Gap-Kalamazoo 3.9 SP and SP Training Communication Skill Assessment Form (GKCSAF) in There were eight SPs to portray the cases. All of communication skills assessment. This tool comprised them were the allied health professionals, including five with 5-point Likert-type scale (1 = poor, 5 = excellent) of social workers and three physical therapists. Their seven original core competencies and two additional working experiences in their field were 2-10 years. Seven competencies namely empathy and communicates of these SPs were females at the age of 25-40 years. Only accurate information. The GKCSAF showed a high one SP was male, aged 28 years. Each SP took for one internal consistency in the previous study, with a patient’s role. The SP training comprised a three-step Cronbach’s alpha of 0.87 and a high inter-rater reliability approach.(24) The first step was a self-study. The second with an ICC of 0.83 (faculty raters) and 0.89 (peer step was the SP and the trainer working out their roles (20) observer raters). together. The third step was the training in which the SP took the patient’s role and the trainer assumed the physician’s role.(24)

50 FP04 The 19th Thai Medical Education Conference December 19-21, 2018 at Mae Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

3.10 Data Collection SP group (M = 29.2, SD = 3.39) and the PRP group (M = After the workshop session, the participants 27.9, SD = 2.59), t(50) = 1.58, p = 0.12. completed questionnaires. Demographic data were A total of 34 (65.4%) physicians completed the collected, including the specialty, age, gender and follow-up assessment, of whom 17 were in the PRP group experience of formal teaching in BBN. Questionnaires and 17 were in the SP group. Table 1 provided the relevant asked them to rate their satisfaction on the training and the sample characteristics. There were 15 (44%) male and 19 perceived effects of the training. The video-record SP (56%) female physicians. No significant group differences encounters of delivering bad news were conducted in one were detected based on gender, age group, and station before the training and two stations within 2 weeks professional experience. Also, no significant within group after the training. differences were found with respect to the participants’ gender (χ2 (1) = 1.07, p = 0.30). Additionally, no 3.11 Data Analysis significant within group differences were found with I used SPSS version 18.0 for data analysis. All respect to the participants’ age group (χ2 (2) = 2.75, p = statistical tests were two-tailed with an alpha level of 0.05. 0.25). Both PRP and SP groups consisted of 5 interns and I analyzed the reliability for all SP encounters and the 12 medical staffs. An independent-samples t-test indicated overall questionnaire with calculating the internal that the mean pretest scores at baseline were significantly consistency statistic Cronbach’s alpha. I analyzed the higher for the SP group (M = 29.2, SD = 2.36) than for the inter-rater reliability for all SP encounters with calculating PRP group (M = 27.4, SD = 1.99), t(32) = 2.41, p = 0.02 the intra-class correlation coefficients (ICC). (Table 1). The demographic characteristics of participants Table 1. Participant characteristics namely gender, age group, and professional experience met the basic assumptions for using the Chi-Square. (25) Characteristics PRP SP p Then, I analyzed the differences in demographic (n=17) (n=17) characteristics between PRP and SP group in terms of Gender gender, age group, and professional experience by using Male 6 9 (25) Female 11 8 0.30 the Chi-Square. Age group The change scores for each measure of the 25-30 8 5 communication performance were determined by 31-40 9 10 subtracting the pretest scores from the posttest scores. The >40 0 2 0.25 pretest score, the change score and the change scores for Interns 5 5 each domain of communication and the ratings for Medical staffs 12 12 satisfaction and the perceived effects of the training Pretest score (M ± SD) 27.4 ±1.99 29.2±2.36 0.02 between the PRP and SP groups met the basic assumptions PRP=peer role play, SP=standardized patient, M=mean, for using independent samples t-test.(26) I used independent SD=standard deviation. Significant difference was set at the level of P < 0.05. samples t-tests to compare the pretest score, the change score, the change scores for each domain of 4.2 Reliability of Instruments communication and the ratings for satisfaction and the The internal consistency of the SP encounters perceived effects of the training between the PRP and SP resulted in the Cronbach’s alpha of 0.88. The inter-rater groups. Moreover, I calculated the effect sizes to reliability ranged from 0.13 to 0.54 for each aspect of determine the magnitude of the differences between the communication. The lowest ICC was noted for the domain pretest scores and the posttest scores using Cohen’s d. of “information gathering” (0.13), while the domains with In addition, the pretest and posttest score of SP the highest ICC’s were “empathy” and “understanding encounters within PRP and SP group met the basic patient” (0.54 and 0.52, respectively). Regarding the assumptions for using paired samples t-test.(26) I used participant’s perspectives on the satisfaction and the paired samples t-tests when I analyzed pre-and post- perceived effect of communication training, the internal intervention assessments in the same participants take part consistency of the questionnaire resulted in the in both conditions.(26) Cronbach’s alpha of 0.86. 4. RESULTS 4.3 Effects of BBN Training 4.1 Subjects A paired-samples t-test showed that scores were significantly higher for the posttest (M = 36.2, SD = 2.35) Fifty-two (49.5%) of 105 physicians resumed the than for the pretest (M = 28.3, SD = 2.34), t(33) = 15.9, p consent form; whereas, the others chose not to join, of < 0.001 (Table 2). The average increased score was 7.90 whom 26 were randomized to the PRP group and 26 were (SD =2.90). randomized to the SP group. All 52 physicians completed the baseline assessment of communication skills. An independent-samples t-test showed that the mean pretest Table 2. The pretest and posttest scores for overall scores at baseline were not significantly different for the participants

51 FP04 The 19th Thai Medical Education Conference December 19-21, 2018 at Mae Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

n M ± SD P participant’s perspectives on the satisfaction and the perceived effect of communication training. A Pretest score 34 28.3 ± 2.34 questionnaire response rate was 58.8% in the PRP group Posttest score 34 36.2 ± 2.35 <0.001 and 35.3% in the SP group. The satisfaction for the Significant difference was set at the level of P < 0.05. training session was high in both groups (4.70 ± 0.48 for M=mean, SD=standard deviation. PRP group, 4.33 ± 0.52 for SP group) with no significant difference in both groups. (Table 4) Moreover, the time 4.4 Effects of BBN Training with PRP and SP spent in training was seen as worthwhile by both groups on Communication Skills Performance (5.00 ± 0.00 for PRP group, 4.67 ± 0.52 for SP group). An independent-samples t-test showed that the Both groups found the training to be very useful (4.90 ± mean pretest scores were significantly higher for the SP 0.32 for PRP group, 4.67 ± 0.52 for SP group). Both group (M = 29.2, SD = 2.36) than for the PRP group (M = groups agreed with the training applicability for future 27.4, SD = 1.99), t(32) = 2.41, p = 0.02 (Table 3). BBN (5.00 ± 0.00 for PRP group, 4.67 ± 0.52 for SP However, the posttest score were not significantly group). different between the two groups. (PRP group (M = 35.7, In sum, the participant’s perspectives on the SD = 1.75) and the SP group (M = 36.7, SD = 2.78), t(32) satisfaction and the perceived effect of communication = 1.29, p = 0.21. Levene’s test indicated the unequal training in all three aspects showed no significant variances (F = 4.48, p = 0.04)). Finally, an independent- difference in both groups. (Table 4) samples t-test indicated that the improved score were not significantly different between the two groups (the PRP Table 4. Satisfaction and perceived effect of communication group (M = 8.28, SD = 2.17) and the SP group (M = 7.51, training Domain PRP SP p SD = 3.52), t(32) = 0.77, p = 0.45 (Table 3)). M ± SD M ± SD Table 3. The pretest and posttest score for the PRP group Satisfaction 4.70 ± 0.48 4.33 ± 0.52 0.17 and the SP group. Training is worthwhile 5.00 ± 0.00 4.67 ± 0.52 0.18 Scores PRP SP P Training is usefulness 4.90 ± 0.32 4.67 ± 0.52 0.35 M ± SD M ± SD Pretest 27.4 ± 1.99 29.2 ± 2.36 Training is applicable 5.00 ± 0.00 4.67 ± 0.52 0.18 Posttest 35.7 ± 1.75 36.7 ± 2.78 Significant difference was set at the level of p < 0.05. M=mean, Change score 8.28 ± 2.17 7.51 ± 3.52 0.45 SD=standard deviation. Significant difference was set at the level of P <0.05. M=mean, SD=standard deviation. 5. DISCUSSION AND CONCLUSION 4.5 Effects of BBN training with PRP and SP 5.1. Discussion on Communication Skills Performance for 5.1.1 The communication skill performance each Domain. Our results were different from the findings from Among the posttest, the change scores were Bosse et al. who compared the use of SP and PRP in the significantly higher for the PRP group than the SP group teaching of a broad medical context of communication in the domain of agreement. An independent-samples t- problems in outpatient medical care to medical test showed that the change scores were significantly students.(11) Bosse et al. showed that the PRP training higher for the PRP group (M = 1.05, SD = 0.31) than for better improved trainees’ performance. They suggested the SP group (M = 0.74, SD = 0.40), t(32) = 2.47, p = 0.02, that PRP led to better result because of the understanding d = 0.85. While an independent-samples t-test indicated of the patients’ perspectives. Thus, PRP may offer a that the improved scores were not significantly different benefit in promotion a more empathic approach.(11) for the PRP group and the SP group in other domains. Our study compared the use of SP and PRP in 4.6 The Participant’s Perspectives of teaching communication skills to interns and physicians, with a focus on one specific challenge in communication Communication Training – breaking bad news in cancer. There was no significant The second aim of this research was to study the difference in score improvement between the two groups. participant’s perspectives on the satisfaction and the Our results concurred with the findings from previous perceived effect of communication training with PRP and studies of Papadakis (14), Mounsey (15) and Lane (16). These SP. After the workshop session, the participants studies also compared the use of SP and PRP in the completed questionnaires which asked for their ratings of training communication skills to medical students and the satisfaction of the training and the perceived effects of health professionals.(14-16) Their results showed that there the training. The independent sample t-test was used to was no significant differences in the scores between the assess the differences in scores from the questionnaires PRP and the SP groups. They concluded that the between the two groups. effectiveness of both methods were comparable. Of the 34 participants, 16 (47.0%) participants There were some similarities among their studies responded to the questionnaires for the assessment of the (14-16) and our present study. All three studies and our study

52 FP04 The 19th Thai Medical Education Conference December 19-21, 2018 at Mae Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence” conducted as a one to two-day training workshop with SP groups. Moreover, both groups stated that the BBN using lecture and small group with PRP compared to SP. training was worthwhile, useful and applicable. Although Moreover, all studies used SP consultation for the satisfactions for the training and all parts of the communication skills assessment. Furthermore, the perceived effectiveness were rated higher in the PRP participants in the study of Lane et al. were health care group, the small numbers of participants may cause no professionals similar with our study which conduct in statistically significant difference between the two groups. interns and medical specialists. The findings of the previous study on teaching However, these studies limited to one task of communication skills with PRP and SP for the communication specifically motivational interviewing for undergraduate medical students reported that all of the smoking cessation.(14-16) While our study focused on one perceived effectiveness were rated higher in the SP specific challenge in communication – breaking bad news group.(21) Whereas, the use of the same training cases and in cancer. the extent of training time were equal across the groups. There were some differences when compared our Also, the role of tutors was limited to just being the study with the study from Bosse.(11) This may be due to resource persons who helped facilitate in both groups. But many issues. First, there was the presence of the the SP’s in this study were not assigned to give feedback professional feedback provided by SPs in the study of to the participants. Therefore, the main learning Bosse, but it was absent in this study.(11) Second, the experiences came from the discussions of group members amount of training time in the study of Bosse was larger in the training with PRP and SP methods.(12, 29,30) The than this study. Third, the sample size in this study was review of literature suggested that the structuring feedback smaller. Fourth, the participants in the study of Bosse were from SP’s was useful for the learning process.(30,31) One medical students, but our study conducted in practicing reason which might elucidate the higher ratings of the physicians. Fifth, this study used VDO recorded SP perceived effectiveness in the SP group was the existence encounters for communication skills assessment while of professional feedback from SP in the previous study, Bosse used OSCE for assessment. Last, the subject but that was absent in the present study.(21) characteristics in Bosse’s study focused on teaching broad medical context of communication problems for the 5.2 Limitations outpatient medical care to medical students, which 5.2.1 Sample size issues differed from this study. First, 52 participants indicated that they were In real-life practice, communication skills interested in participating in this study after the training which take time one to two days is more practical enrollment. All participants were randomly assigned to approach. This study evaluated the effectiveness of receive training to deliver bad news with either PRP or SP. communication skill training for the physicians with PRP At baseline, there was no significant difference between or SP teaching methods. The communication skills, as the pretest scores of the PRP and SP group. However, measured by the GKCSAF scores, showed that both the when the drop out occurred, there were significant PRP and the SP groups had the improvement on the differences in the pretest scores between the remaining GKCSAF scores significantly from the pretest to the PRP and SP groups. However, the change scores were posttest. These findings concurred with the results from determined by deducting the baseline communication skill previous studies that communication skill training with performance score of the SP encounter from the posttest PRP or SP improve communication skills.(27,28) score. This study compared the change scores between the Moreover, our study showed that the change two groups. Second, the sample size was small, which also scores were significantly higher for the PRP group than did not provide the generalization of the findings in this the SP group in the domain of agreement. This domain study. Third, this study was conducted in a single was about mutual understanding of diagnostic or treatment institution with the context of comprehensive cancer plans between physician and patient. When physician center hospital and all participants were postgraduates. discussed about planning to his peer who took the patient’s These conditions limited the generalization of the role, peer had more understanding than SP. Therefore, the findings. It would be necessary to conduct the study with change scores in this domain were significantly higher for other group of doctors, including undergraduates in order the PRP group than the SP group while other domains to generalize the findings of the study. However, this study were not significantly different. demonstrated the benefits of the CST for experienced participants with experience of oncology in a cancer 5.1.2 The participant’s perspectives on center. satisfaction and the perceived effect of 5.2.2 Instrumentation issues communication training. First, this study arranged only one SP encounter The second aim of this research was to study the for baseline and two post-training SP encounters for participant’s perspectives on satisfaction and the communication skill assessment due to time consuming perceived effect of communication training with PRP and and man-power limitations. Second, the communication SP. The satisfaction for the training session was high and skills in this study were collected at two-week intervals no significant differences were present in both PRP and

53 FP04 The 19th Thai Medical Education Conference December 19-21, 2018 at Mae Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence” after the intervention. There was no evidence that this Funding: Master degree scholarship from Chulabhorn change of BBN skills after training would continue over a Hospital longer time frame. Therefore, a future research should Conflicts of interest: none. address the effect of both teaching approaches for the Ethical approval: this study was approved by Siriraj sustainability. Third, the inter-rater reliabilities of the SP Institutional Review Board and Human Research Ethics encounters were low to intermediate, ranged from 0.126 Committee, Chulabhorn Research Institute. to 0.535 for each aspect of communication. The reason for a low ICC would be that the rater training in this study was 7. REFERENCES not true and ideal frame of reference training. Raters [1] Deveugele M, Derese A, De Maesschalck S, would not have the same understanding of a specific Willems S, Van Driel M, De Maeseneer J. dimension for each domain of communication. Fourth, the Teaching communication skills to medical raters were not totally blinded to the sequence of students, a challenge in the curriculum? Patient encounters (pre-training and post-training). It may be Educ Couns. 2005;58(3):265-70. source for biases and make the limitation in interpretation [2] Laidlaw A, Hart J. Communication skills: An of the post-training score. Next, in spite of the acceptable essential component of medical curricula. Part I: reliability of the English version of the GKCSAF Assessment of clinical communication: AMEE instruments, there were no existing translated instruments Guide No. 51. Med Teach. 2011;33(1):6-8. in the Thai version for the assessment of BBN skills. There [3] Keller VF, Carroll JG. A new model for physician- was no translation of the GKCSAF from English into Thai patient communication. Patient Educ Couns. because of the time limitations. The reproduction of this 1994;23(2):131-40. study in the future may require the translation and the [4] Rider EA, Hinrichs MM, Lown BA. A model for edition of tools from the English language into the native communication skills assessment across the language in order to improve the outcomes of the undergraduate curriculum. Med Teach. assessment. 2006;28(5):e127-34. [5] Modi JN, Chhatwal J, Gupta P, Singh T. Teaching 5.3 Conclusion and assessing communication skills in medical This study evaluated the effect of PRP and SP for undergraduate training. Indian Pediatr. teaching breaking bad news of cancer for physicians. The 2016;53(6):497-504. study was conducted in Thailand based on a quantitative [6] Rosenbaum ME, Ferguson KJ, Lobas JG. Teaching method. A one-day training workshop, where physicians medical students and residents skills for delivering practiced with either PRP or SP, could produce a bad news: a review of strategies. Acad Med. significant improvement in the BBN skills following the 2004;79(2):107-17. training. There was no significant difference between the [7] Cleland JA, Abe K, Rethans JJ. The use of use of the PRP and SP in the BBN training workshop. simulated patients in medical education: AMEE Both teaching methods seemed comparable for the BBN Guide No 42. Med Teach. 2009;31(6):477-486. communication skill training and very well accepted with [8] Adamo G. Simulated and standardized patients in the high perceived effectiveness. The obtained OSCEs: Achievements and challenges 1992-2003. experiences from this research could provide useful Med Teach. 2003;25(3):262-270. information for future studies. [9] Bosse HM, Nickel M, Huwendiek S, Schultz JH, Nikendei C. Cost-effectiveness of peer role play 5.4 Implications and standardized patients in undergraduate The findings from this research showed that the communication training. BMC Med Educ. communication skill training for physicians with either 2015;15(1):183. PRP or SP was effective in increasing the effective for [10] Ziv A. Simulators and simulation-based medical teaching BBN in a cancer background compared to the education. In: Dent JA, Harden RM, editors. A training with the SP. Given the cost, time, and resource, practical guide for medical teachers. Edinburgh: the SP can be vital, and the PRP may be a good alternative. Elsevier Churchill Livingstone; 2005.p.211-220. 6. ACKNOWLEDGMENTS [11] Bosse HM, Schultz J-H, Nickel M, Lutz T, Möltner A, Jünger J, et al. The effect of using standardized I would like to thank Chulabhorn Hospital for patients or peer role play on ratings of funding support of Master degree scholarship. I thank undergraduate communication training: A Assoc. Prof. Aaron Calhoun, who gave me the permission randomized controlled trial. Patient Educ Couns. to use the Gap–Kalamazoo Communication Skills 2012;87(3):300-6. Assessment Form (GKCSAF) for this study. I thank to all [12] Nestel D, Tierney T. Role-play for medical experts who provided their suggestions for the research students learning about communication: instrument and all documents needed for the workshop Guidelines for maximising benefits. BMC Med session. Educ. 2007;7(1):3.

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[13] Lane C, Rollnick S. The use of simulated patients [25] Moore DS, McCabe, George P. Introduction to the and role-play in communication skills training: A practice of statistics: W.H. Freeman, New York; review of the literature to August 2005. Patient 1999. Educ Couns.2007;67(1/2):13-20. [26] Field AP. Discovering Statistics Using SPSS for [14] Papadakis MA, Croughan-Minihane M, Fromm Windows: Advanced techniques for beginners: LJ, Wilkie HA, Ernster VL. A comparison of two Sage Publications, Inc.; 2000. methods to teach smoking-cessation techniques to [27] Aspegren K. BEME Guide No. 2: Teaching and medical students. Acad Med. 1997;72(8):725-7. learning communication skills in medicine-a [15] Mounsey AL, Bovbjerg V, White L, Gazewood J. review with quality grading of articles. Med Teach. Do students develop better motivational 1999;21(6):563-70. interviewing skills through role-play with [28] Kurtz SM, Silverman J, Draper J. Teaching and standardised patients or with student colleagues? learning communication skills in medicine: Med Educ. 2006;40(8):775-780. Radcliffe Pub.; 2005. [16] Lane C, Hood K, Rollnick S. Teaching [29] Joyner B, Young L. Teaching medical students motivational interviewing: Using role play is as using role-play: Twelve tips for successful role- effective as using simulated patients. Med Educ. plays. Med Teach. 2006;28(3):225 - 9. 2008;42(6):637-44. [30] Barrows HS. An overview of the uses of [17] Baile WF, Buckman R, Lenzi R, Glober G, Beale standardized patients for teaching and evaluating EA, Kudelka AP. SPIKES-A six-step protocol for clinical skills. Acad Med. 1993;68(6):443-51. delivering bad news: application to the patient with [31] Veloski J, Boex JR, Grasberger MJ, Evans A, cancer. Oncologist. 2000;5(4):302-11. Wolfson DB. Systematic review of the literature on [18] Dias L, Chabner BA, Lynch TJ, Jr., Penson RT. assessment, feedback and physicians' clinical Breaking bad news: A patient's perspective. performance: BEME Guide No. 7. Med Teach. Oncologist. 2003;8(6):587-96. 2006;28(2):117-128. [19] Khan KZ, Gaunt K, Ramachandran S, Pushkar P. The Objective Structured Clinical Examination (OSCE): AMEE Guide No. 81. Part II: Organisation & Administration. Med Teach. 2013;35(9):e1447-63. [20] Peterson EB, Calhoun AW, Rider EA. The reliability of a modified Kalamazoo Consensus Statement Checklist for assessing the communication skills of multidisciplinary clinicians in the simulated environment. Patient Educ Couns. 2014;96(3):411-8. [21] Bosse HM, Nickel M, Huwendiek S, Jünger J, Schultz JH, Nikendei C. Peer role-play and standardised patients in communication training: A comparative study on the student perspective on acceptability, realism, and perceived effect. BMC Med Educ. 2010;10(1):27. [22] Khan KZ, Gaunt K, Ramachandran S, Pushkar P. The Objective Structured Clinical Examination (OSCE): AMEE Guide No. 81. Part II: Organisation & Administration. Med Teach. 2013;35(9):e1447-63. [23] Hauenstein NMA, McCusker ME. Rater training: Understanding effects of training content, practice ratings, and feedback. Int J Select Assess.

2017;25(3):253-66. [24] Furman GE. The role of standardized patient and trainer training in quality assurance for a high- stakes clinical skills examination. Kaohsiung J

Med. 2008;24(12):651-5.

55 FP04 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

QUICK RESPONSE FOR EVALUATION OF CLINICAL PRACTICE IN MEDICAL STUDENT

Onrumpa Kanlapakornchai1, Warisa Tanakurutham1, Onanong Noomcharoen1, Supanut Sirikuichayanonta1, Chuenrutai Yeekian2

1 Center of Medical Education, Queen Savang Vadhana Memorial Hospital, 290 Jermjompol road, Sriracha, Chonburi, 20110, Thailand 2 Center for supporting and developing research, Queen Savang Vadhana Memorial Hospital, 290 Jermjompol road, Sriracha, Chonburi, 20110, Thailand

E-mail: [email protected]

ABSTRACT

One of the most important processes in medical education is a rapid report learning outcomes. The obstetrics and gynecology course have many activities in clinical practice and examination led to use more than sixteen evaluation paper forms. Quick response or QR code is easy to use by smart phones, and the data were immediately sent to be analyzed at that time. G Suite for Education is a cloud- based suite that helps the clerkship to connect and get work done from anywhere on any device. Therefore, the 16 evaluation paper forms of obstetrics and gynecology course were designed in Google forms, and the QR code of each student was done from its URL. When the instructors scan QR code of the student, the processes of evaluation were as follows: 1) Evaluation system shows name and surname of the student for verification. 2) The instructors select type of evaluation forms based on the activity. 3) The instructor provided score of the student and click “sent” button. 4) Data were sent to the clerkship by G Suite for Education. The satisfactions of QR code system were evaluated by the instructed questionnaires to the instructors, staffs, and students. There were 25 persons answer the questionnaires those were 10 instructors, 2 staffs, and 13 medical students. For the 10 instructors, most of them were female (8 out of 10) with age average 38.7 (SD 7.4) years old. The 2 staffs were female, and had age 24, and 34 years old. For the 13 students, they were 21-24 years old, and 54% or 7 from 13 were female. Their opinions about the QR code system were as follows. The average scores of opinions about the QR code system of the instructors, staffs, and medical students were 9.5, 9.0, and 8.7 scores out of 10 scores, respectively. For instructors, the highest score were shown in the topics; decrease volume of using paper (10.0 (SD 0.0) scores), decrease processes of sending the score (9.9 (SD 0.3) scores), can sent the score quickly (9.9 (SD 0.3) scores), respectively. The staffs’ satisfactions were high in topics as follow; easy and convenience to use, receive the score from instructors quickly, documents don’t be lost, and decrease processes of working (all items rate at 9.5 out of 10 scores). For the students, they satisfied in topics that documents don’t be lost, and decrease burden; carrying the documents at all time (rate at 9.2 out of 10 scores).

Keywords: QR code, Evaluation, G Suite for Education

1. INTRODUCTION Collecting scores of clinical practice and examination is one of the most important processes to report learning outcomes in medical education. The rapid feedback of learning is benefits for both instructors and students to improve their performances. Center of Medical Education of Queen Savang Vadhana Memorial Hospital has begun to be an institute of medical student for 10 years. The executive manager of the center aware on creativity and developing an evaluation system that is one of the challenges issues for improvement of quality and standardized the educations especially in the clinical practices context. Regarding the evaluations of learning outcomes, the original system used paper documents to obtain the scores after learning period from the instructors. However, using paper by this method caused many problems in

56 FP31 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

the evaluation system such as 1) report delay, 2) lost documents, 3) waste paper, and 4) problems of document storage. For the instructors and students, it was not convenience to carry the documents during the course, therefore, sometime they forgot and lost it. The obstetrics and gynecology course have many activities in clinical practice and examination led to use more than sixteen evaluation forms of paper. Those evaluation forms have varies contents based on the units in the hospital and activities of the course that the student needed to pass the practice such as delivery room, antenatal care, topic discussions etc. One of the strategic of center of clinical medicine was an integration technology into the working system. Inclusion of technology within medical education has been recommended by Education Quality Assurance Agencies. Also, one technology innovation finding its way into the classroom is the use of QR code1 that is easy to use by smart phones, and the data were immediately sent to be analyzed at that time. In addition, the QR code- link feedback as a high usability platform was reported by the family medicine clerkship2. The study confirmed that this platform resulted in faster from completion than paper or online forms3. The QR code was used in the providing instructional feedback and recording an evaluation of resident competency immediately following surgical procedure, and the satisfaction with and use of, the evaluation system was high3. However, few studies had been reported the use of QR code in medical education. The center of medical education of the study hospital has introduced the G Suite for Education into the working processes in 2017. It is a cloud-based suite that helps the staff of the center to connect and get work done from anywhere and anytime on any device. To integrate the information technology into the evaluation system that aim to enhance the effectiveness of an immediately report learning outcomes, therefore; the sixteen evaluation forms of paper of the obstetrics and gynecology course were modified into the Google form storage in order to use in the evaluations of clinical practice and examination. The satisfactions of QR code system were evaluated by the instructed questionnaires that received from the instructors, the clerkship, and students.

2. OBJECTIVES 2.1 To create the evaluations of clinical practice and examination online by QR code 2.2 To enhance the effectiveness of an immediately report learning outcomes 2.3 To evaluate the satisfaction of the instructors, students, and clerkship for using QR code in the evaluation system

3. MATERIAL AND METHOD The QR system for evaluations of clinical practice and examination online has 2 parts including part I: Creating the QR system, and part II: Evaluating the QR code system. The details of those 2 parts were as follows:

Part I: Creating the QR system 1) Designed the 16 evaluation forms of paper of the obstetrics and gynecology course into the Google form 2) Copied URL link of online forms from Google form 3) Created QR code of each student (Figure 1)

Name Surname

Figure 1. QR Code of student

4) After the activities, the instructors used their mobile phone to scan the student’s QR code (Figure 2) that shown the student’s data (Figure 3). The instructors rechecked the student’s data.

57 FP31 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

Name Surname

Figure 2. Instructors scan QR code Figure 3. Student’s data

5) The instructors selected type of forms (Figure 4)

Figure 4. Type of document forms for evaluation clinical practice

6) The instructors provided the scores in each item of the forms, and sent the data (Figure 5).

Figure 5. provided the scores in each item of the forms

58 FP31 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

7) The data were sent to G Suite for Education, then the staff of the Center of Medical Education could easy access, analyze, and report the learning outcomes (Figure 6).

Figure 6. Data worksheet from G Suite for Education

Part II: For evaluating the QR code system, there were three forms of satisfaction questionnaires to request the instructors, the staff, and students. The content validity of those questionnaires was done by three medical doctors. The reliability of the questionnaires of instructors and students were 0.74 and 0.53, respectively.

4. RESULT There were 25 persons answer the questionnaires those were 10 instructors, 2 staffs, and 13 medical students. For the 10 instructors, most of them were female (8 out of 10) with age average 38.7 (SD 7.4) years old. The 2 staffs were female, and had age 24, and 34 years old. For the 13 students, they were 21-24 years old, and 54% or 7 from 13 were female. Their opinions about the QR code system were as follows.

The average scores of opinions about the QR code system of the instructors, staffs, and medical students were 9.5, 9.0, and 8.7 scores out of 10 scores, respectively (Table 1-3). For instructors, the highest score were shown in the topics; decrease volume of using paper (10.0 (SD 0.0) scores), decrease processes of sending the score (9.9 (SD 0.3) scores), can sent the score quickly (9.9 (SD 0.3) scores), respectively (Table 1). The staffs’ satisfactions were high in topics as follow; easy and convenience to use, receive the score from instructors quickly, documents don’t be lost, and decrease processes of working (all items rate at 9.5 out of 10 scores) (Table 2). For the students, they satisfied in topics that documents don’t be lost, and decrease burden; carrying the documents at all time (rate at 9.2 out of 10 scores) (Table 3).

59 FP31 The 19th Thai Medical Education Conference December 19-21, 2018 at Mah Fah Luang University, Chiang Rai, Thailand “Leadership Towards Medical Education Excellence”

Table 1 Scores of opinions of instructors about the QR code system (n=10) (rating = 1-10 scores)

Topics Mean (SD) Decrease volume of using paper 10.0 (0.0) Decrease processes of sending the score 9.9 (0.3) Can sent the score quickly 9.9 (0.3) Ready to use at anytime and anywhere 9.6 (0.7) Easy and convenience to use 9.5 (0.5) Correctly evaluation, and right person 9.3 (1.0) Descriptions on the interface are clearly 9.0 (1.0) Send complete data because of the alert signal when incomplete data 8.7 (1.7) Overall satisfaction 9.4 (1.0) Average 9.5 (0.5)

Table 2 Scores of opinions of staffs about the QR code system (n=2) (rating = 1-10 scores)

Topics Mean (SD) Easy and convenience to use 9.5 (0.7) Receive the score from instructors quickly 9.5 (0.7) Documents don’t be lost 9.5 (0.7) Decrease processes of working 9.5 (0.7) Report score timely 9.0 (0.0) Ready to use at anytime and anywhere 8.5 (0.7) Decrease volume of using paper 8.5 (0.7) Send complete data because of the alert signal when incomplete data 8.5 (0.7) Overall satisfaction 9.0 (0.0) Average 9.0 (0.5)

Table 3 Scores of opinions of medical students about the QR code system (n=13) (rating = 1-10 scores)

Topics Mean (SD) Documents don’t be lost 9.2 (0.7) Decrease burden; carrying the documents at all time 9.2 (0.7) Ready to use at anytime and anywhere 8.9 (0.9) Easy and convenience to use 8.4 (1.9) Know the score quickly 8.1 (2.4) Overall satisfaction 8.5 (1.3) Average 8.7 (0.7)

5. DISCUSSION This study confirmed that the instructors, staffs, and the student informed positive feedback on use of QR system to evaluate of clinical practice and examination online in the obstetrics and gynecology course. To enhance the effectiveness of an immediately report learning outcomes, the instructors reported that the QR system in this study could decrease volume of using paper, decrease processes of sending the score, and sent the score quickly. While the staffs described that it was easy and convenience to use, they could receive the score from instructors quickly, the documents don’t be lost, and decrease processes of working. For the students, they expressed that the QR system could save their scores in term of “documents don’t be lost”, and it could decrease their burden from carrying the documents at all time. Likewise, the previous study discussed that QR codes are free to generate and may be cost-effective compared with other technologies that cost to use1, and this platform resulted in faster form completion than paper or online forms2. By the success of rapid response on learning outcomes from this study, the Center of Medical Education will authorize this QR system to others medical departments. In this study, the QR system has been started in the obstetrics and gynecology course that led from the head of department, and most of the instructors were female with age average 38.7 (SD 7.4) years old. This might reflex that they are in the age that ready to change, and be familiar with information technology. Also, the previous study explained that implementation of a QR code system is dependent on a social norm shift, therefore; users must recognize the relative advantage and ability of innovation before adopting it into practice2.

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This study intended to demonstrate how to diffuse the innovation to evaluate of clinical practice and examination. Additionally, future research is needed to determine with more samples or comparative between traditional and new innovations. The authors would like to thanks the board of Center of Medical and Center for supporting and developing research, Queen Savang Vadhana Memorial for kindly supporting, and all participants in this study.

6. REFERENCES

[1] Zurmehly J. Using Quick Response Codes in the classroom: Quality Outcomes. CIN 2017: 35(10): 505-511. [2] Matthew J, Snyder DO, Dana R, Nguyen MD, Jasmyne J, et al. Testing Quick Response (QR) codes as an innovation to improve feedback among Gographically separated clerkship sites. Fam Med 2018; 20(3):188- 94. [3] Raynold K, Barnhill, D, Sias J, Young A, Polite FG. Use of the QR reader to provide real time evaluation of residents’ skills following surgical procedures. Journal of Graduate Medical Education 2014; 6(4):738-41.

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TEST-ENHANCED CASE-BASED LEARNING: A RANDOMIZED TRIAL Siriporn Thitisagulwong MD 1*, Cherdsak Iramaneerat MD, PhD 2, Tripop Lertbannapong MD 3

1 Master of Science Program in Health Science Education, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd., Bangkoknoi Bangkok 10700 Thailand. 2Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd. Bangkoknoi Bangkok 10700 Thailand. 3Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd. Bangkoknoi Bangkok 10700 Thailand.

*Corresponding Author’s E-mail: [email protected]

ABSTRACT

Introduction: There was a lack of evidence to support the use of test-enhanced case-based learning to promote clinical reasoning skills of medical students. Objectives: To compare the effectiveness of test-enhanced case- based learning with case-based learning alone in undergraduate medical students. Methods: Fifty-eight 4th year medical students, who attended the Department of Obstetrics & Gynecology between June – September 2018, were randomly allocated into two groups: (1) the intervention group, received test-enhanced case-based learning, and (2) the control group, received case-based learning alone. Pretest scores was recorded as base line score of each student. After finished teaching session over a 3-day period, students completed the assessment of clinical reasoning (posttest) with 4 modified essay questions. Results: The two groups had similar means and standard deviations of pretest scores. (t (56) = .417, p = .678) Means and standard deviations of posttest scores in intervention group is higher than the control group, but was not statistical different. (t (56) = -1.143, p = .26). When sub-group analysis was performed, the test-enhanced case-based learning showed significant benefit over case-based learning without test in students with low pretest scores and in posttest I (threatened abortion). Conclusion: Test-enhanced case-based learning is a powerful learning tool for the special group of the students with appropriate topic and proper level of difficulty of the tests.

Keywords: test-enhanced learning, case-based learning, clinical reasoning

assimilation and increase memory retention. Retrieval 1. INTRODUCTION mastery during taking a test also changes to higher-up level of memory retention over time and better Tests are used as summative assessment understanding. 2- 4 Test- enhanced learning demonstrates instruments meant to measure whether students have consistent and robust effects across different health achieved the educational outcomes of the curriculum at professions, learner levels, test formats, and learning 1 the end of a course. Assessment also directly enhances outcomes.5-9 learning. Previous studies from cognitive psychology One of the important learning outcome of recommendation such as that recall previously learned undergraduate medical students is clinical reasoning factual knowledge enhances the ability to recall this skill. Students need to achieve this for effective patient knowledge in the future. Students who engage in effortful, frequent attempts to recall information show care. This ability should not be left to develop by chance. better learning, retention, and transfer than students who Errors in clinical reasoning play a significant role in spend the same time repeatedly studying the same diagnostic inaccuracy. 10 If the teachers know how to material. This effect is also known as “ test- enhanced teach students to develop competence in the integration learning (TEL)”. 2 In education, assessment devices in and synthesis of cognitive awareness we may be able to consideration of teachers and students are test that can empower students to provide better patient care.11 measure the competence of students and allow feedback There is a need for well-designed studies which to conduct subsequence activities to improve their promote clinical reasoning skill. Therefore, the knowledge. Doing the test regularly can add up researchers design a suitable strategy to improve this

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skill, we need to answer the question that testing can & Gynecology. The research was arranged during the enhanced clinical reasoning skill for students, especially rotation of Obstetrics & Gynecology in the case-based in the students experiencing difficulty. Nevertheless, we learning session on the topic of abnormal vaginal are confident incorporating testing exercises within the bleeding. The total number of 4th year medical students academic process can assist case-based learning and help in this academic year 2018 was 87 persons so that each to construct organization system of knowledge. sub-group was comprised of 14-15 students. When the However, as far as we know, there are a few sampling sub- group rotate to study Obstetrics & studies of test-enhanced learning in clinical reasoning Gynecology, the students were randomly divided again skill in medical students. Only one study of the into two groups under the same rules of the previously effectiveness of testing can encourage studying on divided sub-groups; one was the intervention group and clinical reasoning.8 This study used test enhanced the other was the controlled group. This study was learning with key feature questions to compare with case- arranged during the rotation of Obstetrics & Gynecology based learning alone in stimulating clinical reasoning in the case-based learning session of the topic: Abnormal skill. The findings reveal the efficacy of testing effects on vaginal bleeding. clinical reasoning but cannot explain the cognition underlying clinical reasoning that were primarily 3.2 Study design invoked by the tests and that the test may be too easy . This study was a quantitative, randomized Then this study used the valid test that are different from controlled trial. The participants were randomly divided the ones to enhance this learning skill and then assess the into two groups: one is the intervention group and the results to determine whether the test improved the teaching and learning in clinical reasoning skills. other is the controlled group. 3.3 Participants 2. OBJECTIVES OF THE STUDY th The objective of this study was to determine the Fifty-eight students in 4 year undergraduate effectiveness of case-based learning with key feature medical students volunteered to participate in this study. questions compared with case-based learning alone in They had to attend a mandatory course in case-based fostering clinical reasoning in medical students. learning. The researchers informed students about the study before to start of the curriculum in academic year th 3. METHODS 2018. On the first day of the study program in 4 year medical students, they were asked to sign an informed 3.1 Setting consent to take part in the study. The study was arranged according to the The study was conducted among medical Declaration of Helsinki, and was approved by the ethical students in the clinical year Years 4th of the 6 year ( ) - committee of Mahidol University and center of clinical undergraduate curriculum of center of clinical medicine medicine - Rajavithi Hospital & Queen Sirikit National Rajavithi Hospital & Queen Sirikit National Institute of - Institute of Child Health, Institute of Clinical Medicine, Child Health, Institute of Clinical Medicine, Department Department of Medical Services, Rangsit University. of Medical Services, Rangsit University, Bangkok, After the researchers acquired all of the informed consent Thailand The first year is premedical, studied in general . forms from participants, then a stratified randomization nd rd education. The 2 -3 year are preclinical, studied basic were done by gender and performance level. Participants sciences, as well as anatomy, biochemistry, physiology, were assured that all data would be kept confidentially th th pathology and histology. The 4 - 6 year are the last three and anonymously and it was clearly stated that the test clinical years of the curriculum. results would have no impact on their final assessments. All the 4th year medical students were divided to study in 4 departments: Medicine, Surgery, Obstetrics & 3.4 Instrumentations Gynecology, and Pediatrics. The students were randomly There were three tests developed for this study: divided into six sub-groups, according to their sex and (1) Pretest: twenty multiple choice questions (MCQs), (2) their previous performance grading. So each sub-group In class: twenty extended matching questions (EMQs), was comprised of nearly the same distribution of sex, and (3) Posttest: 4 Modified essay question (MEQs). All mean performance grading, and the number of students. tests were developed by an expert committee with three In each rotation time, two student sub- groups study expert obstetricians and gynecologists according to table Medicine; two sub-groups study Surgery; one sub-group studies Pediatrics, and one sub-group studies Obstetrics

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of specification of this topic. The expert committee adjust Figure 1. Diagram describing the randomized, controlled difficulty index for all items. method in this study

3.5 Procedure 3.6 Data collection and data analysis In teaching sessions, when the tests have been In each group of subjects, basic demographic created by an expert committee, a 2-hour instructing characteristics (including age, gender, and performance session was designed to cover the topic of abnormal grading) and the scores of all participants were gathered vaginal bleeding. The teaching session of the intervention and stored in secured computer. All data were compared group and the control group covered exactly the same between the intervention and control groups. The scores case-based information. Prior to conducting the teaching of all participants were presented in mean and standard session, the researcher gave all participants a pretest (20 deviation. The student t-test was used to compare posttest MCQs). scores between the intervention and the control groups. The intervention group was taught through TEL The χ2 was used to compare proportions. The effect size and used twenty extended matching questions (EMQs) will be calculated to determine the magnitude of the with case-based learning, while the control group was differences between baseline scores and post-training taught case-based learning without any test. The questions scores. The threshold for statistical significance will be in case-based learning were “key history points”, “most set at p 0.05. Statistical analyses were carried out with relevant physical examination that is needed in this case”, SPSS Statistics for Windows, Version 17.0 (SPSS Inc., “most likely differential diagnosis”, and “investigation Chicago, Illinois, USA). needed for diagnosis”. All teaching sessions were taught using the same lesson plan and one teacher to avoid delivery bias. Approximately three days after completion of the teaching session for both groups, students took 4 4. RESULTS MEQs on the abnormal vaginal bleeding topic. The tests took approximately 90 minutes to complete. At 4.1 Subjects characteristics approximately 1-week after the posttest, students in the Fifty- eight 4th year medical students were control group were taught with additional identical enrolled in this study, twenty-eight in the intervention EMQs. In order to provide fairness in the learning group and thirty in the control group, there was no experience, each student attained equivalent operation student missed or contaminated in both groups. Basic for each teaching session. Students in both groups were demographic data of the two groups were not statistically taught on consecutive days. Two members of the significant. (Table 1) researcher team independently scored each posttest in a blinded fashion. Discrepancies were resolved by the Table. 1 Demographic characteristics of the participants discussion of the experts’ opinion. Intervention Control Statistic (N=28) (N=30)

Gender Female 18 (48.60) 19 (51.40) χ2 = 0.006,

Male 10 (47.60) 11 (52.40) p = 0.94

Age group

20-21 12 (52.20) 11 (47.80) χ2 = 3.646, 22-23 10 (41.70) 14 (58.30) p = 0.71 24-27 6 (54.54) 5 (45.46)

Performance grading

> 3 13 (46.43) 17 (56.67) χ2 = 0.608,

< 3 15 (53.57) 13 (43.33) p = 0.79

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Pretest scores have similar means and standard Posttest deviations between the two groups. (t ( 56) = . 417, Posttest I 59.21 + 13.35 47.53 + 19.60 <.05 p = .678) (Table 2) Posttest II 51.82 + 18.97 50.23 +18.24 .75

Table 2. Mean and SD of pretest score Posttest III 34.25 + 11.56 36.43 + 11.89 .49

Group Intervention (28) Control (30) p Posttest IV 53.79 + 11.77 53.85 + 13.68 .99

Pretest score 51.60 + 13.95 50.17 + 12.35 .678 Pretest score < 60 208.70 + 34.94 186.60 + 32.63 <.05 4.2 Posttest scores The internal consistency reliability was used to determine the degree of test score consistency in posttest 5. DISCUSSION AND CONCLUSION (Modified essay questions). The internal consistency of 5.1 Discussion the posttest resulted in the Cronbach’ s alpha of 0. 48. This study compared the effectiveness of test- (Table 3) enhanced case-based learning and case-based learning Table 3. Posttest scores (Mean + SD) and reliability alone on the common gynecologic problem (abnormal Posttest Clinical Mean + SD Cronbach's vaginal bleeding) in undergraduate medical students. No. diagnosis Alpha From the assumption, based on an analysis of the I Threatened 53.17 + 17.73 literature, case-based learning with key feature questions abortion is more effective than case-based learning alone in II Cervical cancer 51.00 + 18.45 .48 strengthening clinical reasoning 8 Results showed that III DUB 35.37 + 11.68 . IV Submucus 53.82 + 12.68 the efficacy of case-based learning with key feature myoma questions is superior to case-based learning in promoting clinical reasoning in special groups of students (low 4.3 Comparison of posttest score by sub- pretest scores) and proper difficulty of the tests. These results are reinforce the benefit of testing in the group analysis between the two groups development of clinical reasoning skill. Most previous Means and standard deviations of posttest studies on the effectiveness of test-enhanced learning in scores in intervention group are higher than the control group but there was no statistic significant. ( t (56) = -1.143, medical education vary in study design, study population, level of knowledge, sample size, learning p = .26). outcomes, testing format, length of retention. When sub-group analysis was performed to The one MEQ (threatened abortion) had a higher compare mean score of two groups, the result showed mean score in the intervention group than the control posttest scores No. I (threatened abortion) and pretest group and showed statistics significantly. One scores of students that were below 60 were specific explanation is appropriate topic may conceptually more factors that were statistically significant between the two cohesive than others that have more disparate set of groups. (Table 4) principle to learn and apply. My results can be compared with those of earlier studies, there are similarities Table 4. Comparison of posttest score by sub-group analysis between this study and report by Raupach and between intervention and control group colleagues8. Although this study demonstrates that Intervention Control effects elicited by test-enhanced learning may help Group p Mean + SD Mean + SD students that struggle with the curriculum. This study calculated the number of subjects by Performance grading using data from Phelps RL12, which summarized in the > 3 221.08 + 29.42 208.71 + 32.80 .29 previous studies, among quantitative studies, mean effect sizes (d) range from 0.55 - 0.88. The researcher chose the < 3 190.47 + 33.20 174.65 + 33.32 .22 high effect size from this range to calculate the sample Gender size resulting in the number of students in each group of 22. Our overestimation of the effect of test-enhanced Female 209.75 + 30.45 195.29 + 38.16 .21 learning led us to Type II error. A study with a large Male 195.55 + 41.21 191.63 + 35.74 .82 sample size might produce statistic significant.

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An analysis of literature demonstrated that characteristics including age, gender, and performance clinical reasoning achievement in medical students must grading. However, there were still many other variables have at least two processes: pattern recognition and that might have effects on the findings that were not analytic process in nature.13 Pattern recognition is used in controlled such as learning styles, attitudes, and interests easier cases. Although more complex cases require more of students. These uncontrolled variables might be in-depth processing.14 Three components of clinical different between the intervention and control groups reasoning based on an obtainable solid knowledge base, and may have affected the study results to some extent. deliberate practice and metacognitive processes.15 Due to Secondly, the important limitation in this study limitation of our teaching schedule, the researcher start is the frequency of repeated testing and learning. All my study in the second week (6 weeks course) and had students in the study had only one time in learning and posttest examination 3 days after my teaching for testing that may be not enough for fostering clinical decreased the maturation of study. Most of students did reasoning skills. Another way to improve repeated testing not yet have opportunity to learn theory and deliberate and learning is simulated patient encounter. It is time- practice about diseases in those presenting with consuming and necessitates noteworthy instructors. abnormal vaginal bleeding. Clinical reasoning is complex Computer-assisted learning and testing can create for students, to achieve this outcome, the curriculum frequent learning opportunities to all students and should provide time scheduling that is regular and provide economies of scale. Testing with immediate frequent in every major departments to develop this skill feedback for “correct” and “incorrect” to the students’ effectively for the students. So, it was difficult for answer can contain explanations of all items. applying their previous knowledge to solve the posttest Thirdly, this study used only one topic MEQ examination that contained other cases than those (abnormal vaginal bleeding). If used in many topics, presented with abnormal vaginal bleeding, only 50-60% students can apply this skill in repeated process to of students passed the MPL of posttest MEQ another topics. Then this competency will improve better. examination. Integration of knowledge in clinical reasoning are The result of this study differed from the study 8 difficult because inadequate application of factual by Raupach and colleagues ,who studied performance of knowledge that is needed to solve the problems. Retrieval clinical reasoning in undergraduate medical education practice again and again will strengthen clinical using repeated testing with key feature questions and reasoning skill. repeated case-based learning alone. Repeated testing by Finally, to decrease the maturation threat to using computer-assisted case-based learning not only 16 validity of study, the researcher provided posttest improved long term retention , but also standardize the examination 3 days after teaching session that might have content coverage and provided equivalent learning effects on the results of the study. Clinical reasoning skill opportunities to all students.17 This study does not development needed time to retrieval knowledge employ computer-assisted case-based learning. This frequently. One possible way to increase the confidence might explain the different results. and decreased the maturation of the study is to use many A number of studies have found that testing can topics and increasing number of interventions in the intensify learning. In medical education that uses posttest crossover study. format such as short answer questions18, essays19, 7 simulated patient encounters , and key feature questions.20 For decrease testing threat, the researcher use test-enhanced learning format as extended matching 5.3 Conclusion questions and posttest format as modified essay Test-enhanced case-based learning is a powerful questions (series and sequence of questions based on a teaching tool for instructors to help struggling students case scenario, with a short text possible answers). develop clinical reasoning skill. Educators should include TEL in health 5.2 Strengths and limitations professions curricula to enhance recall, retention, and The strength of this study includes the transfer. Ideally, “tests” should be repeated, spaced over randomized study design and use only one teacher in time, utilize items that require production of information, teaching session in order to decrease implementation and include feedback with the correct responses and threat to validity. rationale. There are some limitations in this study. Firstly, the researcher used stratified random sampling design 6. ACKNOWLEDGMENTS and tried to control many important subject

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The researchers would like to thank my [10] Yates J, James D. Predicting the “strugglers”: case- colleagues: Commander Prapon Jaruyawongs, MD. and control study of students at Nottingham University Somchai Siricharoenthai, MD. for giving their time and Medical School. BMJ 2006;332(7548):1009-13. expertise to this research study. [11] Kassirer JP. Teaching clinical reasoning: case-based Funding: this study was funded by the center of clinical and coached. Acad Med 2010;85(7):1118-24.3. medicine - Rajavithi Hospital & Queen Sirikit National [12] Phelps RP. The effect of testing on student Institute of Child Health, Institute of Clinical Medicine, Department of Medical Services, Rangsit University. achievement, 1910-2010. Int J Testing 2012;12:21-43. Conflicts of interest: none [13] Croskerry P. A universal model of diagnostic reasoning. Acad med 2009;84(8):1022-8. Ethical approval: this study was approved by the ethical [14] Elstein AS, Schwartz A. Clinical problem solving committee of Mahidol University and center of clinical and diagnostic decision making: selective review of the medicine - Rajavithi Hospital & Queen Sirikit National cognitive literature. BMJ 2002;324(7339):729-32. Institute of Child Health, Institute of Clinical Medicine, Department of Medical Services, Rangsit University. [15] Dunphy BC, Cantwell R, Bourke S, Fleming M, Smith B, Joseph KS, et al. Cognitive elements in clinical 7. REFERENCES decision-making: toward a cognitive model for medical education and understanding clinical reasoning. Adv [1] Larsen DP, Butler AC, Roediger HL. Test-enhanced Health Sci Educ Theory Pract. 2010;15(2):229-50. learning in medical education. Med Educ [16] Larsen DP, Butler AC, Roediger HL. Repeated 2008;42(10):959-66. testing improves long-term retention relative to repeated [2] Roediger HL, Butler AC. The critical role of retrieval study: a randomised controlled trial. Med Educ practice in long-term retention. Trends Cogn Sci 2009;43(12):1174-81. 2011;15(1):20-7. [17] Wahlgren CF, Edelbring S, Fors U, Hindbeck H, [3] Roediger HL, Karpicke JD. Test-enhanced learning: Stahle M. Evaluation of an interactive case simulation taking memory tests improves long-term retention. system in dermatology and venereology for medical Psychol Sci 2006;17(3):249-55. 5. students. BMC Med Educ 2006;6:40. [4] Roediger HL 3rd, Karpicke JD. The power of testing [18] Dobson JL, Linderholm T. Self-testing promotes memory: basic research and implications for educational superior retention of anatomy and physiology practice. Perspect Psychol Sci 2006;1(3): 181-210. information. Adv Health Sci Educ Theory Pract 2015; [5] Green ML, Moeller JJ, Spak JM. Test-enhanced 20(1):149-61. learning in health professions education: A systematic [19] Larsen DP, Butler AC, Roediger HL. Comparative review: BEME Guide N0. 48. Med teach. 2018;40(4):337- effects of test-enhanced learning and self-explanation on 50. long-term retention. Med Educ 2013; 47(7):674-82. [6] Baghdady M, Carnahan H, Lam EW, Woods NN. Test- [20] Gordon J. ABC of learning and teaching in medicine: enhanced learning and its effect on comprehension and one to one teaching and feedback. BMJ diagnostic accuracy. Med Educ. 2014;48(2):181-8. 2003;326(7388):543-5. [7] Larsen DP, Butler AC, Lawson AL, Roedinger HL. The importance of seeing the patient: test-enhanced learning with standardized patients and written tests improves clinical application of knowledge. Adv Health Sci Educ Theory Practice 2013;18(3):409-25 [8] Raupach T, Andresen JC, Meyer K, Strobel L, Koziolek M, Jung W, et al. Test-enhanced learning of clinical reasoning: a crossover randomised trial. Med Educ 2016;50(7):711-20. [9] Kromann CB, Jensen ML, Ringsted C. the effects of testing on skills learning. Med Educ. 2009;43:21-7.

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STRUCTURED REFLECTIVE WRITING TO INCREASE CONFIDENCE LEVELS IN EMERGENCY OBSTETRIC ANESTHESIA OF NURSE ANESTHETIST STUDENTS

Patcha Hortrakul1, Sahatsa Mandee2, and Kasana Raksamani3

1 Master of Science Program in Health Science Education, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd. Bangkoknoi Bangkok 10700 Thailand. 2,3 Department of Anesthesiology Faculty of Medicine Siriraj Hospital, Mahidol University 10700, 2 Wanglang Rd. Bangkoknoi Bangkok 10700 Thailand.

*Corresponding Author’s E-mail: [email protected]

ABSTRACT Introduction: There is a lack of studies comparing the effectiveness of using the structured reflective writing and the structured feedback and normal descriptive reflective writing and the general feedback. Objectives: The purpose of this experimental study was to compare the confidence level after went through the learning methods the structured reflective writing and the structured feedback for the improvement of confidence level to the application of normal descriptive reflective writing and the general feedback. Methods: 36 nurse anesthetic students (NAS) of Siriraj Hospital, who were the targeted and sampled population by matching-sampling in emergency obstetric anesthesia. The NAS received the 2 types of reflection and feedback following a scenario- based, hands-on workshop in general anesthesia for emergency obstetrics, with the comparison of confidence level before the workshop, immediately after the workshop, and after having completed 2 cases of general anesthesia. All students completed the confidence tests and reflective writing reports. The repeat measured data analysis consisted of frequency, percentage, mean, standard deviation, paired t-test, and ANOVA. Results: There were the changed scores between the 2nd and the 3rd confidence tests after the increased scores of the 1st confidence test for each question, but not significantly different between the groups in all questions. The writing reports of reflection demonstrated that the structured reflective questions could guide the participants to succeed in the depth of reflection more than the non-structured reflective questions.Conclusion: Educator should include the structured reflection writing with structured feedback to could guide the students to succeed in the depth of reflection.

Keywords: Structured reflective writing, Reflection, Structured feedback

1. INTRODUCTION essential knowledge and skills to support overall management of critical situations. The purpose of one-year training program for One of critical situations, the management of Nurse Anesthetist Students, jointly organized by the anesthesia in obstetric emergency cases differs from other Department of Anesthesiology, Siriraj Hospital and the patients due to the physiologic changes related to Royal College of Anesthesiologists of Thailand, was to pregnancy. The Nurse Anesthetist Students (NAS) need to help solve the anesthesiologist shortage problem. The learn the skills in making critical decisions on adverse contents of this training program consisted the theory of 1 anesthesiology, practice and related laws in nurse effects. They also have to change themselves from anesthetist profession. Unlike the registered nurses who nursing professional practice under the supervision to 2 mostly follow orders, the nurse anesthetist tasks are to look manage the critical conditions. At present, to increase the after anesthetized patients and make critical lifesaving likelihood of successful obstetric surgery and reduce decisions. In particular, they are responsible for anesthesia complications with lower maternal mortality, a commonly used anesthetic in elective obstetric surgery patients is a management of pre-operative, intra-operative, and post- spinal block compared to the general anesthesia.3, 4 At operative care in specific situations based on several Siriraj Hospital, most patients both in and out of office criteria. Hence, the training program must provide hours received the spinal block. Particularly, some

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hospitals do not have anesthesiologists, and Thai legal quality, and activities that promote reflection.21 Verbal and regulations do not allow nurse anesthetists to provide the non-verbal reflection can be beneficial for the workplace spinal block. Then, the only option available is to provide or small groups as well as in the assessments compared to general anesthesia. the lectures in classroom. Through reflective writing, To improve the general anesthesia experience in students are part of decision-making and it is essential to emergency obstetric patients, the NAS training program of establish students’ knowledge of influences.2223 Siriraj Hospital has provided a scenario-based, hands-on In the meantime, the two types of written workshop on “General anesthesia for emergency obstetric reflection include non-structured and structured reflective patients” since 2011. According to a prospective study for writing. While, normal descriptive reflection usually 5 workshop evaluation ,the NAS commented that workshop presents with an event and a concrete experience. The did not help to improve their performance skills and self- quality of a non-structured reflective writing report confidence when working with the team in emergencies. depends on the reflective skills. With the structured The lack of confidence to make decisions as a teamwork reflective writing, it is a guidance for students to increase and solve problems in critical situations were crucial. their critical-thinking skills and professional growth.24 From many studies in medical education, there Nevertheless, the written reflection in this study are many presented learning methods to promote critical was based on Gibbs’ reflective writing25 and the 4-level thinking in post-graduation, such as reflection, feedback, framework of Kember & et al.26 deliberate practice, problem-based learning, simulation, Gibbs’ reflective writing was the framework for and experiential learning, etc.6 In the meantime, reflection reflective question guideline as follows: with feedback yields additional benefits and could build the students’ confidence during the tasks.7 Describe Describe, what happened? The conceptual frameworks of this study Feelings How did it make you feel? included constructivist theory, experiential learning Evaluate What was good or bad? theory, critical thinking, self-confidence, reflection, and Analyze What sense could you make of the situation? feedback. (see Figure 1) Conclude What general and specific conclusions could 1. Constructivist theory is a key process in the you draw? learning methods to enhance the professionalism of Action What next, or what would you do next time? 89 medical learner’s capabilities. This set of reflective questions was the guidance 2. Experiential learning is the interaction to increase their critical-thinking skills in reminding of between humans and the environment as extremely their tasks, thus increasing the complexity of reflective important for the development of skills10, with 4-stage thinking.27 It also encouraged the students to reflect on learning processes of the best practice to improve skills their learning through the development of crisis tasks.28 and professionalism.11, 12 The framework of Kember & et al involved the 3. Critical thinking is the intellectual process as content analysis of reflective notes in four levels as: guidelines to beliefs and knowledge.13, 14 In particular, the 1) Non-reflective or habitual action of descriptive critical thinking is a basis of self-confidence improvement explanations on the physical meaning in real situations. as a key process in learning methods to enhance professionalism of medical learner’s capabilities.15 2) Understanding as the thoughtful activity of each individual, using the existing knowledge and the 4. Reflection is a educational principles as comprehension of topics or concepts. potential for a successful learning outcome in the thinking processes applied with practical knowledge for routine 3) Reflection with the application of theories to decision making towards learning and professional interpret the relationships through personal experiences. 16, 17 development. It is a method to engage learners into 4) Critical reflection as higher level of reflection knowledge with procedural skills.18,19 In the medical with time taking in the processes and displaying steps. education setting, reflective thinking can apply into Nonetheless, this 4-level framework of Kember learning processes to enhance professionalism as a basis & et al required teachers’ evaluation to clarify the in the critical life-threatening situations.20 Whereas, there reflective thinking from the reflective report. are three types of reflective communication: verbal, nonverbal, and written reflection. Each type of reflection Feedback as a reflection process with given is essential for the improvement of critical thinking with comments after the students’ performance of self-reflection different impacts, depending on the levels of depth, to enhance complex critical thinking for the correction of poor performance.29 Feedback communication may use

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different types of modalities. Verbal or oral feedback is the guideline. speech conversation between teachers and students, particularly the direct observation of clinical performance. Written feedback is the instructors’ written comments for the completed assignments.30, 31 Meanwhile, two types of written feedback comprise the general feedback and the structured feedback. The general feedback implies whether students have a distorted image of their capability and redress them in the process towards a more accurate Figure 1 Conceptual framework reflection on their performance. The structured feedback connects to the objectives and assist learners to understand the best alternatives.. 2. RESEARCH QUESTIONS, PURPOSE, This study applied the 4-level feedback of Hattie AND HYPOTHESIS & Timperley32 to explore the meaning of feedback and the The research question in this study was whether conceptual analysis for power of the study, as follows: the structured reflective writing and the structured feedback affected the confidence level of the nurse 1) Feedback about the task or product anesthetist students more than the normal descriptive 2) Feedback about the processing of the task reflective writing and the general feedback. 3) Feedback about self-regulation The purpose of this research was to examine the 4) Feedback about an individual person confidence level after the nurse anesthetist students Reflection and feedback are two basic teaching went through the structured reflective writing and the methods in clinical settings. Participants involving in one structured feedback learning method. time of the community experience can acquire greater self- Therefore, the hypothesis was that the structured insight and recognition of the need to engage in service at reflective writing and the structured feedback improved the level of each individual.33 In contrast, those with more the level of confidence more than the normal descriptive than one time of involvement not only recognize the need reflective writing and the general feedback.. to engage in service, but also are able to move beyond the reflection at the individual’s level.29,34 3. METHODS In the meantime, two types of reflection with feedback include non-structured feedback reflection and 3.1 Subject Population structured feedback reflection. Traditional teacher-learner This research study received the approval from assessment focuses on group feedback, which is a simple the IRB Committee of Siriraj Hospital. The subjects were action for a teacher to provide feedback, but it is often very volunteers who participated in the NAS training program poorly effective for an individual student. Descriptive at Siriraj Hospital during the academic year of 2017 feedback comments students towards real reflection from (October 2017- September 2018). All of them were the real performance. In normal teaching method, feedback matched-subjects randomly assigned according to gender, from the teachers’ perceptions may not often focus on age, hospital, and critical experience into one of the two those of the learners. If not complicated, the points of study groups: 1) non-structured reflective writing (NSRW) problems from both perceptions may not at all have an and general feedback group, and 2) structured reflective impact. writing (SRW) and structured feedback group. The sample While, the process of the structured written size calculation was based on the score of mean and SD reflection maintains the guided reflective questions to help from the previous study of New General Self-Efficacy the scope of writing.35 The structured reflective writing Scale.27 The calculated statistics in this study yielded a combined with the facilitative feedback may likely to total sample size of 36 subjects. After the completed impact students for new knowledge, deeper discussion enrollment, there were 36 NAS volunteering to participate enhancing the students’ reflective capacity, and new ways in this study. of action planning.9 3.2 Research Design Gibbs’ reflective writing framework and Hattie & All participants completed the tests to assess their Timperley’s four levels of feedback appeared in many 1st demographic data and the confidence level before the studies as the guided reflective questions and feedback workshop of general anesthesia in emergency obstetric patients. The workshop addressed 4 scenarios: 1) Parturient

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with placenta previa, 2) Fetal distress, 3) Severe preeclampsia with HELLP syndrome, and 4) Retained placenta. After the workshop, all participants received the reflective writing form to follow on their group patterns. Then, all participants received the 2nd confidence test after the reflective writing of the workshop. They obtained feedback in two days for their group patterns. The first expert applied the structured feedback with the 4 levels of framework suggested by Hattie & Timperley to the SRW group while the second expert used the general feedback with the real contents from the report of the NSRW group. The participants completed the 2nd and the 3rd reflective writing after the 1st and 2nd collected data of general anesthesia in emergency obstetric patients according to real situations. They received feedback in two days to follow their group patterns after the researcher got the reflective writing reports. After the 3rd reflective writing and feedback, all participants obtained the 3rd confidence test for last data collection. Four participants dropped out in the 2nd and the 3rd follow-up of the two groups. The reasons for declining the follow-up was their unavailability.

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NAS invited to participate (n=36)

NAS who agreed to participate (n=36)

2 weeks Matched-subject using Demographic data (gender, age, before workshop hospital, and critical unit experience)

SRW Group (n=18) NSRW Group (n=18)

1st confidence test 1st confidence test

Scenario-based, hands-on workshop in

“general anesthesia for emergency obstetric patients” One day workshop 1st SRW report 1st NSRW report

2nd confidence test 2nd confidence test

1st Structure Feedback 1st General Feedback

2 drop outs in st both SRW and 1 general anesthesia for emergency obstetric obstetric patients NSRW Group due to ยฟะระ unavailability 2nd SRW report 2nd NSRW report

2nd Structure Feedback 2nd General Feedback

2 months nd 2 general anesthesia for emergency obstetric obstetric patients after workshop

rd 3 SRW report 3rd NSRW report

3rd Structure Feedback 3rd General Feedback

3rd confidence test 3rd confidence test

Figure 2 Overall research procedure

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3.3 Studied instruments the program SPSS version 18.0 (SPSS Inc, Chicago, Illinois) was at a significance set of .05. 3.3.1 The test of confidence level 3.4.3 Reflective writing reports There were two parts of test for the confidence level, including: There were 3 times of reflective writing reports for each participant, with the verification of contents for Part 1: Demographical characteristics validity. The 2 researchers independently reviewed each Part 2: Confidence test (applied from the report to identify the broad ideas for the meanings of confidence level of general anesthesia of emergency phrases or statements in the students’ reflective writing obstetric patients in 2011)5 The test had 10 questions with reports. The closely identified coding was based on 5-level Likert Scale in: Procedures (3 questions), different irrelevant descriptions by Kember & et al. The Management processes (3 questions), Critical thinking (3 result of reflective thinking development demonstrated questions), and Satisfaction (1 question). The validation of the frequency of keywords every time with comparison the original version was the confidence level with a high between the groups, not an individual sample. The internal consistency of the Cronbach’s alpha = 0.813. researcher designed keywords to identify linguistic features and textual moves commonly associated with 3.3.2 The reflective writing reports the depth of the 4 levels. It comprised the pattern of each assigned group. Two experts in general anesthesia for emergency obstetric patients verified the translated contents of those 4. RESULTS questions from English to Thai. The SRW reports 4.1 Validity and reliability of instruments contained 8 opened-end questions according to the 4.1.1 The confidence test framework suggested by Gibbs. Whereas, the NSRW The internal consistency of the confidence test reports contained the opened-end questions that led to in this study yielded the Cronbach’s alpha = .689. general reflection. 4.1.2 The reflective questions of testing 3.3.3 Feedback guide The use of Index of Item-Objective Congruence It was for teachers to provide feedback to was for the verification of content validity. One expert students with the pattern of each assigned group (the evaluated each item with a rating of +1, 0, and -1. Whilst, general feedback and the structured feedback). Two five experts in general anesthesia of emergency obstetric experts in general anesthesia for emergency obstetric patients verified the test for training and development. patients verified the translated contents of the question The SRW contained 8 questions and one question in the from English to Thai. The structured feedback guide was NSRW. The IOC for each question was 0.6-1.0. Two in accordance with the 4-level framework by Hattie & experts were the expertise nurses in anesthetics with Timperley. Meanwhile, the general feedback guide experience on feedback. consisted of real contents from the reflective reports. 4.2 Demographic characteristic data 3.4 Data analysis Most of the subjects (86.1%) were female, aged 3.4.1 Descriptive statistic data 25-30 years (69.4%). The mean age was 28.2 ± 4.67 years. Descriptive statistic data included gender, age, The most setting of hospital (94.4%) was the work with hospital, and critical unit experience. The use of IBM anesthesiologists. About 63.9% of them had their SPSS, version 18 (SPSS Inc, Chicago, Illinois) was for experience in critical unit of less than 2 years. There were data analysis as mean, frequency, and standard deviation. no significant group differences based on gender, age, setting of hospital, and experience in critical unit. 3.4.2 The confidence level Table 1. Demographic data of characteristic of sample The confidence level scores consisted of the 5- SRW NSRW P- level Likert Scale calculated by One-way ANOVA, with (N=18) (N=18) the repeated-measure of the 3-time analysis. The applying value of paired t-test was to identify a significant difference in Gender Male 3(16.7%) 2(11.1%) performance within the groups. While, the use of Female 15(83.3%) 16(88.9%) .630 independent sample t-test was for comparing the Age 25-30 12(66.7%) 13(72.2%) changing scores between both groups. For all analyses,

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31-35 6(33.3%) 5(27.8%) .717 Time SR NSR p- group group Setting of hospital value Mean±SD Mean±SD With 17(94.4%) 17(94.4%) Preworkshop: 3.36 ± .41 3.27 ± .46 .573 anesthesiologists Without 1(5.6%) 1(5.6%) 1.000 The confidence levels before anesthesiologists intervention Experience in critical unit Postworkshop1: 3.46 ± .24 3.40 ± .23 .517 <2 years 12(66.7%) 11(61.1%) The 2nd confidence levels

2-5 years 4(22.2%) 4(22.2%) Postwoekshop2: 3.79 ± .18 3.83 ± .20 .507 rd >5 years 2(11.1%) 3(16.7%) .651 The 3 confidence levels

Significant difference was set at the level of P<0.05. Out of the 108 distributed reflective writing reports, there were 100 returned reports with the 4.3 The confidence test response rate of 92.6%. When comparing the percentage, The mean and SD of the 1st confidence level in the level of the habitual actions and understanding in the the SRW and the NSRW groups were 3.36 ± .41 and 3.27 SRW group showed no difference from the NSRW group. The level of reflection in the written structured ± .46, respectively. The 2nd confidence level was 3.46 ± group demonstrated more frequency of students than the .24 in the SRW group and 3.40 ± .23 in the NSRW group. NSRW group. Only the SRW group could engage in the The 3rd confidence level was 3.79 ± .18 in the SRW group critical reflection. and 3.83 ± .20 in the NSRW group. For the compared, there was no difference between the groups. Also, the 4.5 The words of confidence of reflective note nd rd scores of the 2 and the 3 confidence test were not The level of reflection in written code st significantly different from the 1 confidence test demonstrated the reflection abilities. The process was between the groups. based on the protocol of Kember et al following the Table 2. The pretest and posttest score theory and deduction in the discussed contents of reflective notes The NSRW reports revealed various 1st reflection 2nd reflection 3rd reflection . contents while the focus of the SRW reports was in the SRW NSRW SRW NSRW SRW NSRW question guide. There were sub-themes in the reflective (n=18) (n=18) (n=16) (n=16) (n=16) (n=16) reports of the NSRW group, but the overall pictures were Habitual 18 18 16 16 16 16 the same for the SRW group. action (100%) (100%) (100%) (100%) (100%) (100%)

Understanding 17 15 16 12 16 11 (94.4%) (83.3%) (100%) (75.0%) (100%) (68.8%) 4.5.1 Non-structure reflective writing group Reflection 18 2 16 2 16 1 The question provided to the NSRW group was: (100%) (11.1%) (100%) (12.5%) (100%) (6.35%) “What did you learn from the situations in the anesthesia Critical 18 0 13 0 14 0 for emergency obstetric patients?” reflection (100%) (0%) (81.3) (0%) (87.5%) (0%) The content analysis of the NSRW group Significant difference was set at the level of p < .05, SR indicates structure showed that the students engaged in the habitual actions, reflective writing; NSR indicates non-structure reflective writing understanding, and reflection. All students engaged in the 4.4 Level of reflection habitual actions. About 70% engaged in the understanding. Less than 10% engaged in the reflection. The analysis of reflective reports was 3 times No participants engaged in the critical reflection. following the contents of reflection based on the four levels of written reflection by Kember & et al as follows: The examples of reflective writing contents in 1) Habitual action, 2) Understanding, 3) Reflection, and 4) the NSRW group were: Critical reflection. Habitual actions level Table 3. Frequency of reflective writing “…I have learnt the GA for emergency obstetric patients that addressed the anesthesia management of parturient with placenta previa…” Understanding level

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“…This situation required to prepare many 4.5.3.1 The feeling in situation drugs and equipment before starting operation, such as Wording of the feeling in situation was the intra-venous line and fluid, vasopressor drug, and keyword reflected in all three times of the students’ difficult airway tools…” reflection. These reflective wordings revealed their Reflection level perception of the thinking processes between the “…Before starting general anesthesia in the feelings, both positive and negative. emergency obstetric patients, I had to do the pre- 80% of the students wrote their good feelings in oxygenation to increase FRC. I must prepare LMA for situation, such as gladness and proudness. One student unplan of difficult intubation because obstetric patients wrote: experienced the physiological change at their airway…” “I felt more confidence more than before” 4.5.2 The Structured reflective writing group Students wrote their bad feelings in situation, There were eight questions provided to the such as excitement, anxiety, and fear. One student wrote: students in the SRW group. “It was very excited…I felt sad when I failed in The content analysis of reflective writing in the the intubation process” SRW group showed that the questions guided the 4.5.3.2 Improvement of themselves students to think in many aspects of situations. They not only could make description, but they also were able to 50% of the students wrote that they had more define and assess high reflection in the written tasks. confidence and skills in themselves and improved their knowledge to manage the situation. One student wrote: The examples of reflective writing contents in the SRW group were: “I felt more confidence than before despite the intubation because I learned the preparation to prevent risks.”

Finally, the students of the NSRW question Habitual actions level group engaged in the habitual actions, understanding, “I have learnt the general anesthesia for and reflection. While, those of the SRW question group emergency obstetric patients which addressed the engaged in the habitual actions, understanding, anesthesia management of 4 scenarios” reflection, and critical reflection. Importantly, both Understanding level groups involved in the two sub-themes with the critical “I would read rapid sequence induction and thinking determined as the feeling in situation and self- general anesthesia in OBG patient knowledge before improvement. working. Then, I would have good management in 4.6 Feedback to participants general anesthesia patients.” 4.6.1 Feedback to the non-structured reflective Reflection level writing group “I would read more contents of hypotension to have more confidence and success in emergency General feedback was for the control group. One obstetric patients and general anesthesia management” of the experts provided the individual written feedback to participants in 3 days via email. Feedback typically Critical reflection level commented on the students’ insights to support their “In the future, I would maintain only one case. I engagement. The general feedback consisted of real had to decide and manage the team to solve the contents from the report of the NSRW. immediately events. This was so that I could prepare drugs and instruments including the components before The examples of reflective note and feedback to starting the case of requisites…” NSRW group were: Reflective note “Before starting general anesthesia in 4.5.3 Sub-themes of reflective writing emergency obstetric patients, I had to do the pre- Moreover, the answers consisted of eight oxygenation to increase FRC. Moreover, I must prepare questions and the content analysis showed two sub- LMA for the non-planning of difficult intubation because themes that determined the critical thinking.

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obstetric patients experienced the physiological change - I agree with you that the concern for the at their airway” equipment of difficult airways is most important. Feedback from the researcher 2) Feedback about the processing of the task “That was excellent. You were aware of the situations in - Don’t forget to concern for the call for help critical cases. In addition, the preparation of equipment and team working. was basic management in general anesthesia for emergency obstetric patients. Keep fighting.” 3) Feedback about self-regulation 4.6.2 Feedback to structured reflective writing - Reading the books and having awareness of situations are basic for preparation before starting every group case. The reports of the SRW group contained eight - you have a good forward thinking with the questions. The provision of feedback from the experts concern on your self-performance and knowledge. was in 3 days after receiving the reports. The guideline for feedback included the 4 levels of framework 4) Feedback about an individual person suggested by Hattie & Timperley to the SRW group. - That is good for planning. 1) Feedback about the task or product - In addition, you must try to calm down in 2) Feedback about the processing of the task emergencies when you are confronted with critical cases. 3) Feedback about self-regulation 4) Feedback about an individual person 5. DISCUSSIONS 5.1 Discussion of the results and hypothesis The examples of reflective note and feedback to This study aimed to explore the efficacy of the SRW group were: SRW and the structured feedback to increase the Reflective note confidence level of the NAS more than the NSRW and “I should have my concentration in the task and the general feedback. Also, it would be essential to prepare all important equipment. identify the effect of using the reflective writing and feedback many times to improve the confidence level of Excited I should have knowledge. the NAS. However, the scores on the 2nd and the 3rd I needed to read the rapid sequence of induction confidence test were not significantly different from the and had general anesthesia in OBG patients before 1st confidence test between the groups. working. Then, I would have good management in Moreover, the students’ reflective reports could general anesthesia patients. define the level of written reflection. In the meantime, the Failing and no confidence. questions in the SRW could guide the students to think in many aspects, such as feeling, future planning, and weak I could do faster and correct. points deeper than the NSRW. I should read the books before working. 5.1.1 Discussion of findings from the confidence More confidence for the next cases.” scores Feedback from researcher The question in this study aimed to examine the “That’s so good for the planning. I agree with efficacy of the SRW with structured feedback and the you that the attention for the equipment of difficult NSRW with general feedback. The result of this study airways is most important. Moreover, you have a good showed that the confidence score of the SRW and forward thinking with the concern on your self- structured feedback group was not significantly different performance and knowledge. Reading books and from the NSRW and general feedback group. In this situation awareness are the basic preparation before study, there was a little difference between the groups in starting every case. In addition, you must try to calm the confidence level. There were some reasons to explain down in emergencies when you encounter critical cases. the findings in this study: Don’t forget to pay attention to the call for help and team- First, the sample size in this study was small working.” with no adequate power to detect the effect of the intervention. Analysis of feedback content 1) Feedback about the task or product

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Second, the data collection on the confidence was small with no adequate power to detect the effect of level should be 3 times for 2 weeks-3 months with the the intervention. The investigation of Sanders et al and completed results, not at the same time. Aronson et al was based on a larger group of students to draw the more precise conclusion about the effectiveness Third, with the 3-time confidence test in this of both teaching methods. It was helpful to determine the study, the students obtained different experience in the probability of detecting an effect of a given size with a workplace training which depended on their schedule. given level of confidence, under the sample size Fourth, each student had time for the self- constraints. Second, the amount of collecting time in the directed learning with the contents of general anesthesia studies of Sanders et al and Aronson et al were shorter in emergency obstetric patients. than this study. Third, following the 3-time confidence test in this study, students obtained different experience

5.1.2 Discussion of findings from reflective note in workplace training, which depended on their schedule. This part of the study evaluated the level of In addition, each student had time for self-directed reflective writing report and the confidence level. To learning, which could affect the confidence level of conclude, the SRW questions could guide the students to students. succeed in the depth of reflection more than the NSRW questions. 5.2 Implications The overall findings of this study yielded There were some reasons to support the general implications for research and practice. The students confidence These reasons might explain ’ . NSRW was easy to conduct and required less resources. different experience in workplace training. The training Given the time and resources, the SRW could be schedule of each student limited to different workplace. essential and the NSRW may be a good alternative. The experience of management skills in general Further research should calculate the sample anesthesia in emergency obstetric impacted each student size well A variety and number of sample size could for the reflective writing. . affect the examination and group comparison. Thus, 5.2 Discussion and literature review researchers who are interested in the use of reflection to The results were compatible with the findings in enhance the confidence level require to have the teaching the previous 2 studies of Timmins et al37, 38, which methods with various aspects of reflection. focused on the nurses’ reflection skills among students. 5.4 Limitations This study compared and explored the reflective reports and the coded theme following the reflection model of 5.4.1 Study samples Gibbs, which presented that the structured reflection This study limited the small sample size of 18 improved the writing skills and also increased the higher students in each group. Second, the time of reflection in level of overall performance. The mean score for the this study was with different intervals after the students’ assignments using the model with structured intervention. scores was higher than those who did not utilize the structured model. 5.4.2 Instrumentation However, these results as well consisted the There were no existing instruments with the findings from Sanders et al27, which compared the translated reflection in Thai version. structured and the non-structured writing in contrast with the reflections. The results of Sanders et al indicated that 5.5 Conclusion the students who wrote the structured reflections There was no significant difference between the significantly increased their personal growth and self- use of the structured reflection writing with structured efficacy. Whereas, those using the non-structured feedback and the non-structured reflection writing with reflections showed no changes. Moreover, the study general feedback for the improvement of the confidence results of Sanders et al supported the findings of Aronson level among the nurse anesthetist students. 24 et al , which demonstrated the structure of critical Educator should include the structured reflection with feedback guideline to improve effective reflection writing with structured feedback to could reflection and confidence interval, compared to the non- guide the students to succeed in the depth of reflection. reflection guideline and feedback. There were some reasons to explain the findings in this study, with no consistence to those in Sanders et al and Aronson et al. First, the sample size in this study 6. ACKNOWLEDGEMENTS

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The authors would like to thank Anesthesiology [14] Hurley MH, Hurley D. Enhancing Critical Thinking Department of Siriraj Hospital and Mahidol University Skills Among Authoritarian Students. High Educ. for their support. 2013;25(2):248-62. Conflict of interest: None [15] Bell A, Kelton J, McDonagh N, Mladenovic R, Ethical approval: This study was approved by the ethical Morrison K. A critical evaluation of the usefulness committee of Mahidol University. of a coding scheme to categorise levels of reflective thinking. High Educ. 2011;36(7):797-815. [16] Sandars J. The use of reflection in medical 7. REFERENCES education: AMEE Guide No. 44. Med Teach. [1] Elisha S, Rutledge DN. Clinical education experiences: perceptions of student registered nurse 2009;31(8):685-95. anesthetists. AANA J. 2011;79(4 Suppl):S35-42. [17] Winchester TM, Winchester MK. A longitudinal [2] Phillips JK. Exploring student nurse anesthetist investigation of the impact of faculty reflective stressors and coping using grounded theory practices on students' evaluations of teaching. Educ methodology. AANA J. 2010; 78(6):474-83. Tech. 2014;45(1):112-24. [3] Joy LHM. Epidural Analgesia for Labor and [18] Department of Agriculture's National Institute of Delivery. 2010; 362(16):1503-10. Food & Agriculture ; The Ohio State University. [4] Hughes C, Aderson G, Patterson D, O'Prey M. Introducing an obstetric emergency training Communication : Personal Reflection.: The Ohio strategy into a simulated environment. B J Mid. State University; 2014. 2014; 22(3):201-8. [19] Aronson L, Niehaus B, Lindow J, Robertson PA, [5] พัชรียา นิวัฒน์ภูมินทร์, วรรณา ศรีโรจนกุล. การประเมินการสอน O'Sullivan PS. Development and pilot testing of a ปฏิบตั ิการระงบั ความรู้สึกแบบท้งั ตวั ในผปู้ ่วยสูติกรรมแบบ reflective learning guide for medical education. Med Teach. 2011;33(10):e515-21. ฉุกเฉินแก่นกั ศึกษาวิสัญญีพยาบาล. Thai J Anes.2555; [20] Stevens FCJ, Goulbourne SJD. Globalization and 38(3):207-18. the modernization of medical education. Med [6] Koh YH, Wong ML, Lee JJ. Medical students' reflective writing about a task-based learning Teach. 2012;34(10):e684-9. experience on public health communication. Med [21] Fischer MA, Haley HL, Saarinen CL, Chretien KC. Teach. 2014;36(2):121-9. Comparison of blogged and written reflections in [7] Branch WT, Paranjape A. Feedback and reflection two medicine clerkships. Med Educ. 2011;45(2):166- teaching methods for clinical settings. Acad Med. 75. 2002; 77(12):1185-9. [22] Caeiro C, Cruz EB, Pereira CM. Arts, literature and [8] Dennick R. Constructivism reflections on twenty reflective writing as educational strategies to five years teaching the constructivist approach in promote narrative reasoning capabilities among medical education. Int J Med Educ. 2016;7:200-5. physiotherapy students Physiother Theo Pract [9] Virginia R. Constructivist Pedagogy. Teach Col . . Rec. 2003;105(9):1623-40. 2014;30(8):572-80. [10] Nalliah S, Idris N. Applying the learning theories to [23] Kennison M. Developing reflective writing as medical education:A commentary. IeJSME. Effective Pedagogy. Nurs Educ Pers. 2014;33(5):7. 2014;8(1):50-6. [24] Aronson L, Niehaus B, Hill-Sakurai L, Lai C, [11] Koponen J, Pyorala E, Isotalus P. Comparing three O'Sullivan PS. A comparison of two methods of experiential learning methods and their effect on teaching reflective ability in Year 3 medical medical students' attitudes to learning students. Med Educ. 2012;46(8):807-14. communication skills. Med Teach. 2012;34(3):e198- [25] Cochran GL, Brookes DT, Kramer LH. A 207. framework for assessing learning assistants' [12] Kolb DA. Experiential education Experience as the reflective writing assignments. AIP Conference source of learning and development. New Jersey: Proceedings; 2013; Florida. USA. Miami; 2013. 2014 [26] Kember D, McKay J, Sinclair K, Wong FKY. A [13] Liu K. Critical reflection as a framework for four category scheme for coding and assessing the transformative learning in teacher education. level of reflection in written work. High Educ. Educational Review. 2013;67(2):135-57. 2008;33(4):369-79. [27] Sanders MJ, Van Oss T, McGeary S. Analyzing Reflections in Service Learning to Promote

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Personal Growth and Community Self-Efficacy. J Experiential Educ. 2015;39(1):73-88. [28] Stark P, Roberts C, Newble D, Bax N. Discovering professionalism through guided reflection. Med Teach. 2006;28(1):e25-31. [29] Corrigan R, Hardham G. Use of technology to enhance student self evaluation and the value of feedback on teaching. Ther Rehab. 2011; 18(10):579- 91. [30] Algiraigri AH. Ten tips for receiving feedback effectively in clinical practice. Med Educ Online. 2014;19(25141):8. [31] Overeem K, Wollersheim H, Driessen E, Lombarts K, van de Ven G, Grol R, et al. Doctors' perceptions of why 360-degree feedback does (not) work: a qualitative study. Med Educ. 2009;43(9):874-82. [32] Hattie J, Timperley H. The Power of Feedback. Educ Res. 2016;77(1):81-112. [33] Quinton S, Smallbone T. Feeding forward: using feedback to promote student reflection and learning – a teaching model. Educ Teach Int. 2010;47(1):125- 35. [34] Kneebone R, Nestel D. Learning Clinical skill the place of simulation and feedback. Cli Teach. 2005;2(2):86-90. [35] Jones AH. Literature and Medicine A Problem of Assessment. Acad Med. 2006;81(10):128-37. [36] Timmins F, Murphy M, Howe R, Dennehy C. “I Hate Gibb's Reflective Cycle 1998” (Facebook©2009): Registered Nurses’ Experiences of Supporting Nursing Students’ Reflective Practice in the Context of Student's Public Commentary. Procedia – Soci Behav Sci. 2013;93:1371-5. [37] Timmins F, Neill MF. Reflections on Reflection: An Audit of Students’ use of Structured Models Within Specific Assessments. Procedia - Soci Behav Sci. 2013;93:1368-70.

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