의과대학 입학도구에 지역사회, 교수, 학생의 가치 반영하기 (Teach Learn Med. 2005)

의과대학 입학도구에 지역사회, 교수, 학생의 가치 반영하기 (Teach Learn Med. 2005)

Reflecting the Relative Values of Community, Faculty, and Students in the Admissions Tools of Medical School

Harold I. Reiter Kevin W. Eva 

McMaster University Department of Clinical Epidemiology and Biostatistics Hamilton, Ontario, Canada

두 번째 천년을 마무리지으며, 미국과 캐나다에서는 의사에게 요구되는 특질attribute을 정의했을 뿐 아니라, 이 특질들을 postgraduate와 practice 수준까지 강화하기 위한 교육과정과 평가 프로세스를 강화하였다. ACGME의 six competencies, 캐나다의 “Educating Future Physicians of Ontario,” , Core Committee of the Institute for International Medical Education 의 일곱개 역량 영역.

In the concluding years of the second millennium, efforts were under way in both the United States and Canada not only to define the attributes desirable in our physicians but also to foster curricular and evaluative processes to enhance those attributes at the postgradu- ate and practice levels.

• In the United States, efforts by the American Board of Medical Specialties and by the Accreditation Council for Graduate Medical Educa- tion produced a document describing the six compe- tencies expected of physicians.1
• A parallel movement in Canada, arising from the project “Educating Future Physicians of Ontario,”2 led to the creation of CanMEDS 2000 and its seven roles of the physician.3
• From a global perspective, the Core Committee of the Institute for International Medical Education has grouped the essentials that physicians must have under seven competence domains.4

인지적 역량과 대비되는 개인 역량, 개인 인성에 대한 강조는 우연의 일치가 아니다. 전통적으로 인지적 능력을 평가하기 위한 도구들은 비교적 성공적이었지만, 인성 역량을 평가하기 위한 도구는 아주 드문 예외를 제외하고는 신뢰도와 타당도가 떨어진다.

The emphasis on personal, as opposed to cognitive, qualities in that reviewis no accident. As clearly dem- onstrated in an earlier, separate literature review6 of ad- missions tools to health professional schools, tradi- tional tools for the evaluation of cognitive qualities have largely succeeded, although those evaluating per- sonal qualities, with rare exception, have failed to dem- onstrate reliability and validity.

MMI는 이러한 측면에서 상당한 진전이었다.

A significant step in the development of those tools was taken with the advent of the Multiple Mini-Interview (MMI).7

방법

Methods

학부 입학시에 중요한(관련된) 일곱 개의 인적 특성에 대한 리스트를 만들었다. 이 정의는 comprehensive하지는 않지만, 가이드로 사용될 수 있을 것이다.

Adapting the roles, competencies, and competence domains outlined in Table 1 in conjunction with the lit- erature on admissions and local discussion, we created a list of seven personal characteristics that could be conceived to be relevant in an undergraduate admis- sions context. These characteristics, along with the definitions provided to participants, are illustrated in Table 2. Participants were told that these definitions were not comprehensive but that they should serve as a guide.

paired comparison approach에 따라서, 7개를 서로 비교하는 21개 문항을 만들었다. 아래와 같은 instruction

Following the paired comparison approach,12 a questionnaire was created by listing all pairs of these 7 characteristics (e.g., collaborative versus ethical) and randomizing the order in which the items were presented. Participants were given the following instruction.

더 중요하다고 생각하는 것을 선택해주세요

For each pair of characteristics outlined below, please circle the characteristic that you consider more important in determining who should be admitted to the Undergraduate MD Program at McMaster University. You must choose one characteristic from each pair, or your responses will not be analyzed. Definitions for each char- acteristic are provided on the preceding page.

약 10분정도 소요. z score 계산.

Participants responded to 21 pairings; the task re- quired approximately 10 min to complete. From these data, the probability of each item being selected was determined and converted to z scores to determine the relative importance of each of the seven characteris- tics on an interval level scale.

• Negative z scores do not indicate that the characteristic is viewed as in- unimportant—undoubtedly each of the items cluded are valued to some extent.
• Rather, negative z scores simply indicate that the characteristic is less important relative to the other options provided.
• For example, imagine only two items, A and B, were in- cluded in the study, both of which are considered im- portant characteristics. If item A was selected as more important than item B 60% of the time, the probability of selecting item A (0.6) would convert to a z score of 0.26 for item A and the probability of se- lecting item B (0.4) would convert to a z score of –0.26 for item B (see Streiner & Norman13 for an ac- cessible description of the analyses).

Results

그룹을 어떤 식으로 구분하든 z score 결과는 매우 유사했다.

The resultant z score comparisons were remarkably uniform regardless of whether the group under consid- eration was from community, faculty, or the student body. Similarly, homogeneity was observed on com- paring those with more or less intimate administrative level of involvement.

 

 

Discussion

입학 단계에서 실수가 있을 경우 그 결과는 드라마틱하다. 사회적으로 촉발될 수 있는 잠재적 피해 뿐 아니라, 학부의학교육에 들어가는 학생당 비용은 9만달러에 달한다. 균질하게 성공적인 의사결정에 대한 합당한 사회적 기대와 높은 교육 비용을 고려하면 입학과 선발의 판단에서 생겨난 오류를 교정하기 위해 추가적으로 시간, 재정, 노력을 들이는 것은 용납할 수 없다.

The cost of a mis- step in admissions is dramatic. Aside from the poten- tial damage unleashed on society, the financial cost of undergraduate medical education approximates $90,000 (US) annually per student.14,15 Given the rea- sonable expectation of uniformly successful decision making and the high cost of education, any further sig- nificant expenditure of time, money, and effort to remediate errors of judgment by the admissions office is unacceptable.

지난 50년동안 지역사회, 교수, 학생 간 관점에 차이가 유의미하게 다를 것이라는 기대가 있었고, 이는 입학위원회의 구성에 엄청난 변화를 가져왔다. 1957년과 1971년 사이에 입학위원회에 학생이 포함되는 비율은 거의 0%에서 56%까지 늘어났다. 이는 1982년에는 74%까지 늘어났다. 지역사회 인사의 비중이 늘어나는 것은 조금 더 느렸지만 확실히 다가오고 있다. 1971년까지는 3%에서만 포함되어 있었으나 1982년에는 27%까지 늘어났다.

Over the last 50 years, the expectation of significant differences in perspective between community, faculty, and students has promulgated a seismic shift in representation on admissions committees. Between 1957 and 1971, the presence of students on admissions committees of schools affiliated with the Association of American Medical Colleges swung sharply upward, from near nonexistence to 56% (41/73) of committees responding to the survey indicating a student presence.16 This presence continued to rise to 74%(64/86) by the time a similar survey was conducted in 1982.17 The rise of community influence was more delayed, but nevertheless forthcoming. Even by the time of the 1971 survey, only 3% (2/73) of committees reported a community stakeholder presence, although this appears to have risen by the 1982 survey (27% of responding committee memberships arose from non medical–nonprofessional backgrounds in that survey).

이러한 변화를 지지해주는 관점의 차이는 덜 명확하다. 특정 영역에 대한 상대적 중요도 순서를 비교한 연구에서 지역사회 인사와 입학위원회 사이에 공통점이 많았다라는 연구도 있다.

The existence of differences in perspective to warrant these shifts is less clear. A comparison of rank order of the relative importance of particular defined domains was conducted between community members versus members of the Admissions Committee of the University of Massachusetts Medical School (UMMS).18 The study reported that the “results of the rank-ordering of criteria indicate commonalities in outlook and approach between the [community member] conferees and the UMMS Admissions Committee despite the fact that the ranking of the characteristics was done independently” (p. 640). The methodology used by UMMS was, in contrast to the paired comparison analysis described here, far more resource intensive and included a much smaller sample size of stakeholders (n = 20).

이 결과를 바탕으로 윤리적의사결정과 의사소통을 강조하는 MMI스테이션을 만들어야 할 것이다.

These results can now be used to guide the develop- ment of admissions protocols, particularly the MMI, ensuring that the stations are designed to preferentially emphasize ethical decision-making and communica- tion skills.

 

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Teach Learn Med. 2005 Winter;17(1):4-8.

Reflecting the relative values of community, faculty, and students in the admissions tools of medical school.

Reiter HI1, Eva KW.

Author information

• 1McMaster University, Department of Clinical Epidemiology and Biostatistics, Hamilton, Ontario L8N 325, Canada.

Abstract

BACKGROUND:

In defining the characteristics of medical students that society and the medical profession find desirable, little effort has been spent assessing the relative value of the dozens of characteristics that have been identified. Furthermore, many institutions go to great lengths to ensure equal representation across stakeholder groups in an effort to maximize the heterogeneity of the pool of students accepted to study medicine; however, the extent to which different stakeholders value different characteristics has yet to be determined.

PURPOSE:

This study was an attempt to assess the relative value of the characteristics of medical students that society and the medicalprofession find desirable.

METHODS:

Using documents created internationally to identify the core competencies of medical personnel, a series of 7 characteristics were generated for inclusion in a study that adopted the paired comparison technique. Of 347 surveyed, 292 respondents indicated the rank ordering they would assign to each characteristic by circling the more important characteristic in all possible pairings.

RESULTS:

Overwhelmingly, "ethical" was deemed to be the most important characteristic on which selection tools should be based. Surprisingly, the pattern of responses was highly consistent regardless of stakeholder group and degree of affiliation with the undergraduate medical program.

CONCLUSIONS:

The generalizable features of this study not only include the empirical findings but also demonstrate useful survey protocol that can be adapted by any admission committee to guide the generation of an institution-specific admissions blueprint. A novel protocol that provides the necessary flexibility is discussed.

PMID:

 

15691807

 

[PubMed - indexed for MEDLINE]