Ferrin Neal, Zarbock Tylynn, Tieman Michael
Rocky Vista University College of Osteopathic Medicine, Parker, Colorado.
Rocky Vista University College of Osteopathic Medicine, Parker, Colorado.
J Surg Educ. 2020 Jan-Feb;77(1):166-177. doi: 10.1016/j.jsurg.2019.07.001. Epub 2019 Jul 18.
This study seeks to evaluate the psychological and academic effects of grading a medical school simulation course. This study also seeks to evaluate whether a student's class rank affects these results and whether the academic effects of a simulation course persist long-term.
Two separate medical school classes were evaluated. The first class participated in an ungraded surgery simulation course with only formative feedback. The second class participated in a tier-graded course. Qualitative assessment of both courses included daily standardized and self-reported stress surveys, student feedback surveys at the end of the course, and student feedback surveys at the end of the surgery clerkship. Quantitative assessment included pre and postcourse examinations, NBME Surgery Subject Assessment percentile ranks, and COMLEX 2 surgery subscores. Qualitative and quantitative assessments were compared between classes as a whole and between students in the upper and lower half of each class. Results were analyzed using a Student two-tailed t test.
Rocky Vista University College of Osteopathic Medicine Institute of Simulation, Parker, Colorado.
One hundred forty-eight students from the Rocky Vista University College of Osteopathic Medicine Class of 2017 and one hundred fifty-one students from the Rocky Vista University College of Osteopathic Medicine Class of 2018.
Daily standardized stress surveys indicated some increase in stress for students in the graded course, especially for students in the upper half of the graded class. All students adapted to stress significantly by the end of each course, but upper-half students adapted more significantly. Students' self-reported stress levels demonstrated a significant decrease during the ungraded course, but a slight increase during the graded course. Students' self-reported confidence levels rose significantly during the ungraded course, but less significantly during the graded course. Student feedback surveys demonstrated a positive student perception of both courses, but, when stratified, some responses were significantly different between students in the upper and lower half of each class, with upper-half students generally giving a higher rating to the graded course. Clinical knowledge examination scores and improvement in scores within the course were significantly higher for the graded course, with no significant differences between students in the upper and lower half of each class. Students' mean NBME Surgery Subject Assessment percentile rank did not differ significantly between the two classes, but were significantly higher than for previous classes who had not participated in a simulation course. Mean NBME Surgery Subject Assessment percentile rank and COMLEX 2 mean surgery subscore were significantly higher for students in the upper half than for students in the lower half of each class. COMLEX 2 mean surgery subscore did not differ significantly between classes who had participated in a simulation course and previous classes who had not. Students in the upper half of each class in this study performed significantly better than students in the lower half of each class on the mean COMLEX 2 surgery subscore.
This study reaches the following conclusions: (1) objective stress level measurements did not correlate with students' self-reported stress levels; (2) grading a simulation course raises objective stress levels in higher-performing students more than in lower-performing students, but higher-performing students demonstrate the ability to effectively adapt to the increased levels of stress and achieve significant increases in confidence; (3) higher performing students generally demonstrate a greater sense of satisfaction with the simulation course experience when the course is graded; (4) higher-performing and lower-performing students within a class perform in a similar fashion on examinations within the intensely structured environment of a simulation course, whether the course is graded or not; (5) grading a course stimulates all students to perform better on examinations within the course; (6) this higher level of performance and similarity of performance between higher and lower-performing students does not continue when students are not in a structured environment, and students stratify into disparate performance groups in accordance with their class rank; and (7) students exposed to a surgical simulation course perform better on NBME surgery subject examinations than students who have not participated in a simulation course, but this increased level of performance does not extend long-term to national board exams.
本研究旨在评估医学院模拟课程评分对学生心理和学业的影响。本研究还旨在评估学生的班级排名是否会影响这些结果，以及模拟课程的学业影响是否具有长期持续性。
对两个不同的医学院班级进行评估。第一个班级参加了一个只有形成性反馈的无评分手术模拟课程。第二个班级参加了一个分层评分课程。对这两个课程的定性评估包括每日标准化和自我报告的压力调查、课程结束时的学生反馈调查以及外科实习结束时的学生反馈调查。定量评估包括课程前后的考试、美国国家医学考试委员会（NBME）外科科目评估百分位排名以及综合骨科医学执照考试（COMLEX）2外科子分数。对两个班级整体以及每个班级上半部分和下半部分的学生进行定性和定量评估的比较。使用学生双尾t检验分析结果。
科罗拉多州帕克市落基山维斯塔大学骨科医学院模拟研究所。
来自落基山维斯塔大学骨科医学院2017级的148名学生和来自落基山维斯塔大学骨科医学院2018级的151名学生。
每日标准化压力调查表明，评分课程中的学生压力有所增加，尤其是评分班级上半部分的学生。到每个课程结束时，所有学生都能显著适应压力，但上半部分的学生适应得更显著。学生自我报告的压力水平在无评分课程期间显著下降，但在评分课程期间略有上升。学生自我报告的信心水平在无评分课程期间显著提高，但在评分课程期间提高幅度较小。学生反馈调查显示学生对两个课程都有积极的看法，但分层后，每个班级上半部分和下半部分的学生的一些回答存在显著差异，上半部分的学生通常对评分课程给予更高的评价。评分课程的临床知识考试成绩和课程内成绩的提高显著更高，每个班级上半部分和下半部分的学生之间没有显著差异。两个班级的学生平均NBME外科科目评估百分位排名没有显著差异，但显著高于之前未参加模拟课程的班级。每个班级上半部分的学生的平均NBME外科科目评估百分位排名和COMLEX 2平均外科子分数显著高于下半部分的学生。参加模拟课程的班级和之前未参加模拟课程的班级之间的COMLEX 2平均外科子分数没有显著差异。本研究中每个班级上半部分的学生在COMLEX 2平均外科子分数上的表现显著优于下半部分的学生。
本研究得出以下结论：（1）客观压力水平测量与学生自我报告的压力水平不相关；（2）对模拟课程进行评分使成绩较好的学生的客观压力水平升高幅度大于成绩较差的学生，但成绩较好的学生表现出能够有效适应压力增加并显著提高信心；（3）当课程有评分时，成绩较好的学生通常对模拟课程体验表现出更高的满意度；（4）在模拟课程这种高度结构化的环境中，无论课程是否有评分，班级内成绩较好和较差的学生在考试中的表现方式相似；（5）对课程进行评分会促使所有学生在课程内的考试中表现得更好；（6）当学生不在结构化环境中时，这种较高的表现水平以及成绩较好和较差学生之间表现的相似性不再存在，学生会根据他们的班级排名分成不同的表现组；（7）参加外科模拟课程的学生在NBME外科科目考试中的表现优于未参加模拟课程的学生，但这种提高的表现水平在长期的国家委员会考试中并未延续。
