의과대학 입학시 스무고개 수행능력을 통한 임상수행능력 예측 (Med Educ, 2015)

의과대학 입학시 스무고개 수행능력을 통한 임상수행능력 예측 (Med Educ, 2015)

Twenty Questions game performance on medical school entrance predicts clinical performance

Reed G Williams1 & Debra L Klamen2

"지식이 있다"는 것은 무엇인가? - 네 가지가 있음

-'누가'에 대한 지식

-'무엇을'에 대한 지식

-'어떻게'에 대한 지식

-'언제'에 대한 지식

White,2 in a careful analysis of what it means to possess knowledge, concluded that knowledge is manifested as ability and that ability takes many forms. The more typical and easily measured forms of knowledge involve knowing...

• who (e.g. who invented the transistor) or 
• what (e.g. what significant event occurred in New York City on 11 September 2001). 

However, knowing also includes knowing 

• how (e.g. how to ride a bike) and 
• when (e.g. when to add elements to a mixture in a process). 

'안다'라는 것은 단순히 기존에 알려진 답을 다시 되풀이하는 것이 아니라 새로운 문제에 대한 답을 찾아내는 기능을 뜻한다.

Most importantly, White argued that knowing does not merely involve the ability to produce old answers previously acquired, but also the facility to find new answers to new problems.2

기존의 지식은 최소한 다섯 가지 형태로 결합될 수 있다. (사실, 개념과 원리, 절차, 전략, 신념)

To cope successfully with the tasks and demands of everyday life, humans must be proficient in combining previously learned knowledge, skills and attitudes (beliefs) into at least five forms: 

• facts (bits of information); 
• concepts and principles (e.g. knowledge of cause-and-effect relationships); 
• procedures (e.g. knowledge of step-by-step processes regarding how and when to carry out an action, such as in how and when to carry out long division computations); 
• strategies (general methods for approaching problems such as by breaking a problem into parts), and 
• beliefs (e.g. stable attitudes that lead to predictable behaviours, such as beliefs about the factors that lead to patient behaviour changes). 

이 다섯 가지 요소의 다양한 조합을 통해서 업무를 수행하게 된다.

All five fit White’s2 construction of knowledge as ability. Various combinations of these five elements are compiled and drawn upon to meet the various tasks and demands placed on people.

본 연구는 스무고개 게임의 능력이 일상생활에서 얻은 지식과 어떻게 그것을 구조화하고, 효과적으로 저장하여 효율적/효과적으로 인출, 결합, 활용할 수 있는가를 보여줄 수 있다는 전제에서 시작하였다.

The present study is based on the premise that the TQ parlour game tests the knowledge people have acquired in the course of their everyday lives and how well their organising and storing of that knowledge allows them to efficiently and effectively retrieve, combine and use it to address the challenges posed in everyday life.

본 연구에서 가능한 추가적 이점은 '인내심'의 척도로 활용가능하다는 것이다. 답을 맞추지 못하였더라도 20개의 질문을 모두 한 학생이 있고 중간에 포기한 학생이 있다.

A further benefit of this task is that it provides a  measure of perseverance. Students who fail to solve the problem posed and quit before they have used their entire quota of questions may be providing evidence of low perseverance, which may be a negative indicator of potential success as a medical student.

Study design

This was a prospective, longitudinal, observational cohort study. All students entering Southern Illinois University School of Medicine in 2009 were invited to play a single game of TQ on a non-medical topic during the first week of medical school

Description of TQ tasks and game process

Each participating entering student played a single game of TQ in a one-to-one encounter with the investigator at the time of his or her orientation to medical school. The TQ tasks posed were based on non-medical knowledge acquired through normal life experiences. A number of objects (correct answers) were selected in advance. The object (correct answer) for each participant was selected using a random selection process.

The investigator kept an essentially verbatim record of the number and nature of the questions asked and guesses offered by the student. The investigator also kept detailed notes about the strategies used in playing the game.

질문의 접근법을 네 가지로 구분

Based on the notes taken about student performance on the TQ task, a second investigator, blinded to SCCX and diagnosis justification (DJ) performance, classified the performance into one of four groups based on the student’s approach to the task: Essentially random; Somewhat random; Somewhat logical, and Logical.

논리적 접근은 이런 것이다.

These performances: 

(i) started out with broad questions in order to define the right path; 

(ii) built new questions based on previous answers, and 

(iii) offered educated guesses rather than random (off-the-wall) guesses.

Diagnosis justification exercise (진단 정당화 시험)

For eight cases, students were required to provide a written justification for their final diagnosis as part of the post-encounter exercise. The specific instructions given to students were as follows: ‘Please explain your thought processes in getting to your final diagnosis; how you used the data you collected from the patient and from laboratory work to move from your initial differential diagnoses to your final diagnosis. Be thorough in listing your key findings (both pertinent positives and negatives) and explaining how they influenced your thinking’.

Each response was blindly read and rated by two physician judges (the case author and one additional physician who was an expert in diagnostic reasoning). More details on this task and its use have been published in earlier manuscripts.11,12

Logical Group이 하위 두 개 그룹보다 SCCX와 DJ Performance가 우수함

Logical Group이 SCCX와 DJ에서 가장 우수하며 경향성을 보임

답이 틀렸어도 끝까지 20문항을 모두 질문했는지 여부에 따른 차이

DJ exercise 예측력에 있어 MCAT 점수와의 비교

Effect size interpretations (large and medium) are based on conventions described by Kirk.13

다른 의과대학, 문화권에서 확인이 필요함

As with any research results, confidence in these results will increase if the study can be successfully replicated in this and other medical schools. It is especially important to determine whether similar results are observed in other cultures because it is certainly possible, if not probable, that the results will vary based on the child-rearing and educational practices observed elsewhere.

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Med Educ. 2015 Sep;49(9):920-7. doi: 10.1111/medu.12758.

Twenty Questions game performance on medical school entrance predicts clinical performance.

Williams RG1, Klamen DL2.

Author information

• 1Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
• 2Department of Medical Education, Southern Illinois University, Springfield, IL, USA.

Abstract

CONTEXT:

This study is based on the premise that the game of 'Twenty Questions' (TQ) tests the knowledge people acquire through their lives and how well they organise and store it so that they can effectively retrieve, combine and use it to address new life challenges. Therefore, performanceon TQ may predict how effectively medical school applicants will organise and store knowledge they acquire during medical training to support their work as doctors.

OBJECTIVES:

This study was designed to determine whether TQ game performance on medical school entrance predicts performance on a clinicalperformance examination near graduation.

METHODS:

This prospective, longitudinal, observational study involved each medical student in one class playing a game of TQ on a non-medicaltopic during the first week of medical school. Near graduation, these students completed a 14-case clinical performance examination. Performanceon the TQ task was compared with performance on the clinical performance examination.

RESULTS:

The 24 students who exhibited a logical approach to the TQ task performed better on all senior clinical performance examination measures than did the 26 students who exhibited a random approach. Approach to the task was a better predictor of senior examination diagnosis justification performance than was the Medical College Admission Test (MCAT) Biological Science Test score and accounts for a substantial amount of score variation not attributable to a co-relationship with MCAT Biological Science Test performance.

CONCLUSIONS:

Approach to the TQ task appears to be one reasonable indicator of how students process and store knowledge acquired in their everyday lives and may be a useful predictor of how they will process the knowledge acquired during medical training. The TQ task can be fitted into one slot of a mini medical interview.

© 2015 John Wiley & Sons Ltd.

PMID:

 

26296408

 

[PubMed - in process]