Medical Students In Taiwan Research Articles

Assessment of opioid knowledge and attitudes among senior medical students in Taiwan’s pain education curriculum: A cross-sectional questionnaire survey

IntroductionWhile the opioid crisis has been a significant concern in North America, Taiwan has not encountered a similar crisis. This study investigated medical students’ perceptions of opioid therapy for chronic pain management in Taiwan.MethodsA cross-sectional questionnaire survey was conducted among third- and fourth-year medical students who had completed an 18-hour pain medicine curriculum, in comparison with those who did not take the course in Mar 2022 and May 2023. The survey assessed their knowledge, attitude, and perceptions of the opioid crisis in the United States and Taiwan.ResultsIn total, 135 (88.2%) of 153 senior medical students who had completed the curriculum responded to the survey. They exhibited a better understanding of opioids (P < 0.001) and held a more negative attitude toward opioid use (P = 0.011) compared with 105 students who did not take the course. Additionally, out of 240 respondents, 177 (73.8%) acknowledged the ongoing opioid crisis in the United States, while only 70 (29.2%) disagreed with the notion of an ongoing opioid crisis in Taiwan. Furthermore, 90% of all students expressed agreement with the need for further education on chronic pain management after graduation.ConclusionAmong senior medical students in Taiwan, those who completed an elective pain medicine curriculum demonstrated enhanced knowledge of opioids, a more cautious attitude toward opioid use, and a willingness to receive further education on chronic pain management. Over 70% of students remained uncertain or incorrectly believed that there was an opioid crisis in Taiwan.

Impact of liminality and rituals on professional identity formation in physician training.

The transition from medical student to practicing physician affects the complex processes of professional identity formation and professionalism, which have a lasting effect on the physician's career development. This study explored two different transitional processes of medical students in Taiwan, the associated rituals during this transitional period (the 'liminal phase') and their effect on the formation of professional identity. Using snowball sampling, we recruited 13 medical students from two training systems: six from the traditional postgraduate year programme and seven from the accelerated postgraduate year (A-PGY) programme. Semi-structured interviews were thematically analysed to identify significant themes that encapsulated trainees' experiences. A consistent and mutually confirmed discussion ensured the identification of robust recurring themes. A comparative analysis of the two training modalities provided critical insights into the relative impact of the training dynamics. The A-PGY cohort, subjected to an altered 'incorporation' ritual, encountered an influx of unexpected symbolic social power, complicating their transformation within the liminal phase. Without a defined internship like in the PGY system, A-PGY trainees exhibited confusion and inconsistencies in professional identity formation marked by conflicting internal and external perceptions. This ambiguity affected their clinical training, social integration and overall development of professionalism. The absence of a structured, sequential liminal phase increased conflict and diminished motivation, culminating in an incomplete self-crafting journey for A-PGY trainees. This study highlights the impact of the well-sequenced implementation of rituals in liminality on professional identity formation. A good transition training programme for medical students should compass sequential rituals in the liminal phase, including clear starting and ending points, supervision by seniors, guided reflection and plenty of opportunities for observation and imitation in context. Optimal training and pivotal elements in a medical training system warrant delicate design and further research when developing and changing the structure of the training programme.

Dental curriculum for medical students in Taiwan: A preliminary survey

Dental curriculum for medical students in Taiwan: A preliminary survey

Choices of Specialties and Training Sites among Taiwanese Physicians Graduating from Polish Medical Schools.

Taiwanese students who graduated from Polish medical schools (P-IMGs) accounted for the second-largest group of international medical graduates in Taiwan. In 2009, domestic medical students in Taiwan staged mass demonstrations against P-IMG’s exemption from the qualifying test before the licensing exam. Although medical circles in Taiwan might still hold prejudices against P-IMGs, little is known about their career development. This study will analyze P-IMGs’ choices of specialties and training sites from 2000 to 2020 using data from the membership section of the Taiwan Medical Journal, the monthly official publication of the Taiwan Medical Association. Of 372 P-IMGs, 34.2% chose internal medicine and 17.1% surgery. Although academic medical centers offered 76% of all available trainee positions in a year, only 49.3% of P-IMGs received training there. By contrast, 20.9% of P-IMGs were trained at nonmetropolitan hospitals that altogether accounted for only 5.8% of trainee positions. In conclusion, P-IMGs had their residency training at less favorable specialties and sites. Their long-term career development deserves further study.

Development of dental education for medical students in Taiwan during the Japanese colonial period

Background/purposeDuring the Japanese colonial period, Taiwan had a medical school education system for cultivating physicians, but did not have a dental school education system for cultivating “real” dentists. In this investigation, we collected and analyzed the historical documents related to dental education to study the development of dental education for medical students in Taiwan during the Japanese colonial period. Materials and methodsThis study mainly analyzed the changes in the development of dental education for medical students in Taiwan during the Japanese colonial period through the collection and sorting of relevant historical materials. ResultsDuring each stage of Taiwan's medical education system in the Japanese colonial period, the medical school offered compulsory dental courses for medical students, including theory and clinical practice of dentistry. Although there was no specific dental subject included in the graduation examination, evidence showed that the content of dentistry was covered by the subject of Surgery in the examination. Moreover, Taipei Imperial University established the Medical Faculty in 1936. Its curriculum increased the weight of dentistry and added the “Dentistry & Oral Surgery” as a graduation examination subject, indicating the importance of dental education for medical students in that period. ConclusionIn the Japanese colonial period, although there was no dental school for cultivating dentists in Taiwan, there was still dental education for medical students to let them understand the Dentistry and to enable them to become dental practitioners. This can be regarded as a workaround in the medical and healthcare policy.

The Impact of COVID-19 Pandemic on the Learning Outcomes of Medical Students in Taiwan: A Two-Year Prospective Cohort Study of OSCE Performance.

Background/Aims: To avoid the negative impacts of the COVID-19 pandemic on clinical clerkship, supplemental teachings such as digital materials in the scenario-based distal simulations were implemented. This study utilized the OSCE (objective-structured clinical examination) to evaluate the impact of COVID-19 pandemic on the learning outcome of medical students from the regular group (class of 2020) and pandemic-impacted group (class of 2021). Methods: All medical students serially took, firstly, the mock-OSCE, secondly, the mock-OSCE, and the national OSCE. Then, the serial OSCE scores were compared between groups. Results: Although with similar scores in the first mock OSCE, the regular group (n = 78) had a higher average score in the national OSCE than the pandemic-impacted group (n = 80) (872.18 vs. 834.96, p = 0.003). In terms of improvement, the performances of the regular group were also better than the pandemic-impacted group between the second mock OSCE and the national OSCE (79.10 vs. 38.14, p = 0.014), and between the second mock OSCE and the national OSCE (125.11 vs. 77.52, p = 0.003). While separating distinct genres, the regular group had more of a score increment in standardized patient-based stations between the second mock OSCE and the national OSCE (regular vs. pandemic-impacted: 57.03 vs. 18.95, p = 0.003), as well as between the first mock OSCE and the national OSCE (75.97 vs. 26.36, p < 0.001), but there was no significant difference among the skill-based stations. In particular, the scores of the emergency medicine associated station in the national OSCE of the pandemic-impacted group was lower. Conclusions: Our study implies that the pandemic significantly hampered the learning outcomes of final year medical students in their clinical participation. Especially facing the COVID-19 pandemic, more supplemental teachings are needed to compensate the decreasing emergency medicine exposure.

Active learning of medical students in Taiwan: a realist evaluation

BackgroundActive learning is defined as any instructional method that engages students in the learning process. Cultural differences in learning patterns can play an important role in engagement with active learning. We aimed to examine process models of active learning to understand what works, for whom and why.MethodsForty-eight sixth- and seventh-year medical students with experience of active learning methods were purposively selected to participate in ten group interviews. Interactions around active learning were analysed using a realist evaluation framework to unpack the ‘context-mechanism-outcome’ (CMO) configurations.ResultsThree core CMO configurations, including cultural, training and individual domains, were identified. In the cultural context of a strong hierarchical culture, the mechanisms of fear prompted students to be silent (outcome) and dare not give their opinions. In the training context of teacher-student familiarity alongside teachers’ guidance, the mechanisms of learning motivation, self-regulation and enthusiasm were triggered, prompting positive learning outcomes and competencies (outcome). In the individual context of learning how to learn actively at an early stage within the medical learning environment, the mechanisms of internalisation, professional identity and stress resulted in recognising active learning and advanced preparation (outcomes).ConclusionsWe identified three CMO configurations of Taiwanese medical students’ active learning. The connections among hierarchical culture, fear, teachers’ guidance, motivation, the medical environment and professional identity have been shown to affect the complex interactions of learning outcomes. Fear derived from a hierarchical culture is a concern as it is a significant and specific contextual factor, often sparking fear with negative outcomes.

Standard setting made easy: validating the Equal Z-score (EZ) method for setting cut-score for clinical examinations

sBackgroundThis study aims to assess the feasibility, reliability and validity of the panel-based Equal Z-score (EZ) method applied to objective structural clinical examination (OSCE) of Chinese medical students and undertaking a comparison with the statistical techniques-based Borderline Regression Method (BRM).MethodsData received from two cohorts of 6th and 7th year medical students in Taiwan who set the mock OSCE as a formative assessment. Traditionally this medical school uses BRM to set the pass/fail cut-score. For the current study, 31 OSCE panellists volunteered to participate in the EZ method in parallel to the BRM.ResultsIn the conduct of this study, each panel completed this task for an OSCE exam comprising 12 stations within less than 60 min. Moreover, none of the 31 panellists, whose are busy clinicians, had indicated that the task was too difficult or too time-consuming. Although EZ method yielded higher cut-scores than the BRM it was found reliable. Intraclass correlation (ICC) measuring absolute agreement, across the three groups of panellists was .893 and .937 for the first and second rounds respectively, demonstrating high level of agreement across groups with the EZ method and the alignment between the BRM and the EZ method was visually observed. The paired t-test results identified smaller differences between the cut-scores within methods than across methods.ConclusionsOverall this study suggests that the EZ method is a feasible, reliable and valid standard setting method. The EZ method requires relatively little resources (takes about an hour to assess a 12 station OSCE); the calculation of the cut-score is simple and requires basic statistical skills; it is highly reliable even when only 10 panellists participate in the process; and its validity is supported by comparison to BRM. This study suggests that the EZ method is a feasible, reliable and valid standard setting method.

Effectiveness of a theory of planned behavior-based intervention for promoting periodontal preventive behaviors among medical students in Taiwan

Objective To evaluate the effectiveness of an oral self-care education intervention based on the Theory of Planned Behavior in Taiwanese undergraduates. Participants We recruited 63 and 90 students in the experimental group (EG) and comparison group (CG), respectively, from a medical university. Methods A quasi-experimental design was employed. The EG received health education and a brief action and coping planning intervention. Results The EG was significantly more likely to brush for more than 3 minutes (adjusted odds ratio [aOR] = 2.52), use the modified Bass brushing technique (aOR = 7.81), and floss (aOR = 21.21) at the 2-week follow-up than was the CG. At the 6-week follow-up, the combined effect of high action and coping planning with high perceived power for predicting floss use was observed in the EG (p < 0.05). Conclusions Intervention may promote periodontal-disease-preventing behaviors in undergraduates, particularly for achieving adherence to daily flossing.

Harm avoidance and depression, anxiety, insomnia, and migraine in fifth-year medical students in Taiwan.

PurposeDuring medical school training, increased stress, depression, and anxiety are common. Certain personality traits, particularly harm avoidance (HA), may increase the risk of psycho-pathological disorders, insomnia, and migraine among medical students. This study evaluated the role HA may play on levels of stress, depression, anxiety, and insomnia among Taiwanese medical students starting their fifth and final year of medical school.Patients and methodsA series of self-report questionnaires were used to measure the severity of anxiety, depression, and insomnia, as well as somatic symptoms, particularly migraine headache, among 143 Taiwanese fifth-year medical students (94 males and 49 females). Most had normal or mild levels of anxiety, depression, insomnia, and migraine.ResultsHA personality trait was significantly associated with depression (all P ≤ 0.001) after adjusting for other factors. HA was not significantly associated with anxiety, insomnia, or migraine headache days.ConclusionHA personality trait was significantly associated with depression among fifth-year medical students in Taiwan.

Doctor-patient Communication from Doctors' Perspectives

Objectives: Communication skill is one of the categories of core competencies for medical education. Medical education institutes are aware of the importance of techniques of teaching and assessing doctor-patient relationship. However, research on what to teach in this course is limited in Taiwan. The purpose of this study was to develop a course guideline for teaching doctor-patient communication for medical students in Taiwan, which would be informed by a checklist of doctor-patient communication competencies. Methods: Thirteen senior physicians were interviewed by use of an in-depth semi-structured approach. Data of interviews were analyzed by the coding procedure of grounded theory. Results: The study found three categories that affect doctor-patient communication skills. The first category is personal factors that include family experience, gender, year, self-awareness, emotion management, etc. The second category consists of supportive and inappropriate language and behaviors. These include doctors' attitudes, language, explanation for treatment procedure, problem solving, etc. The third category comprises the other negative factors, include the health insurance system, difficult patients, the limitations of medical systems, etc. Conclusions: This research compared the results with competencies developed by other researchers. It also provides instructors of medical education in Taiwan with a better understanding of guidelines for teaching communication courses.

Item response analysis on an examination in anesthesiology for medical students in Taiwan: A comparison of one- and two-parameter logistic models

BackgroundStudent examinations are an essential component of medical education and item analyses are important to assess test quality. Among miscellaneous psychometric theories used for test analyses, item response theory is more flexible and versatile than other theories. This study aimed to apply item response models to analyze an anesthesiology examination for medical and dental students. MethodsThis examination included 50 items that were administered to 170 5th- and 6th-year medical and dental students. One- and two-parameter logistic (1-PL and 2-PL) item response models were used to conduct item analyses of the examination. Fit statistics were examined to exclude misfit items and evaluate test reliability. Goodness-of-fit analyses were used to select the model having the better fit to data. Examinee's ability and item difficulty were estimated and then expressed on the common scale. Potentially differential items were detected using logistic regression. ResultsThe goodness-of-fit analysis revealed that, in our case, the 1-PL model was more suitable for item response analyses. No misfit item was noted and the test reliability was 0.81 (1-PL model). The mean examinee's ability was set at 0 by definition [standard deviation (SD) = 0.61] and the mean item difficulty was −2.08 (SD = 1.93). There were 24 items with a difficulty level lower than the least able examinee, and three items had a difficulty level higher than the most able examinee. Four potentially differential items were identified. ConclusionItem response models are useful for medical test analyses and provide valuable information about model comparisons and identification of differential items other than test reliability, item difficulty, and examinee's ability.

Students’ view upon graduation: a survey of medical education in Taiwan

BackgroundImproving the quality of medical education is a key goal of government policy in Taiwan. The aim of this study was to reflect the responses of medical education from the perspective of graduating medical students in Taiwan. This is the first survey study of medical education in Taiwan.MethodsUsing the Medical School Graduation Questionnaire from the Association of American Medical Colleges (AAMC), we distributed 406 questionnaires to medical students of four medical schools in their last semester, and received 270 back (response rate, 66.5%). There were 11 medical schools in Taiwan. Most questions were assessed on a 5-point Likert scale.ResultsStudents identified genetics, biochemistry, and ethics as the three most important premedical subjects preparing them for medical education and gross anatomy, physiology, and pharmacology as the three most helpful basic science subjects preparing them for clinical clerkships and electives. Most Taiwanese students were satisfied with their learning experience in internal medicine. Only 55.9% of students were confident that they had acquired the clinical skills required to become a resident, and 70.7% were satisfied with the quality of their medical education.ConclusionThe study offers preliminary results on the views of graduating students on the medical education system in Taiwan. In particular, our government and medical educators need to continuously put more effort into building students’ confidence in their clinical skills.

A cross‐cultural study of students’ approaches to professional dilemmas: sticks or ripples

Medical educators internationally are faced with the challenge of teaching and assessing professionalism in their students. Some studies have drawn attention to contextual factors that influence students' responses to professional dilemmas. Although culture is a significant contextual factor, no research has examined student responses to professional dilemmas across different cultures. Semi-structured interviews inquiring into reactions towards, and reasoning about, five video clips depicting students facing professional dilemmas were conducted with 24 final-year medical students in Taiwan. The interviews were transcribed and analysed according to the theoretical framework used in prior Canadian studies using the same videos and interview questions. The framework from previous Canadian research, including the components of principles, affect and implications, was generally applicable to the decision making of Taiwanese students, with some distinctions. Taiwanese students cited a few more avowed principles. Taiwanese students emphasised an additional unavowed principle that pertained to following the advice of more senior trainees. In addition to implications for patients, team members or themselves, Taiwanese students considered the impact of their responses on multiple relationships, including those with patients' families and alumni residents. Cultural norms were also cited by Taiwanese students. Medical educators must acknowledge students' reasoning in professionally challenging situations and guide students to balance considerations of principles, implications, affects and cultural norms. The prominence of Confucian relationalism in this study, exhibited by students' considerations of the rippling effects of their behaviours on all their social relationships, calls for further cross-cultural studies on medical professionalism to move the field beyond a Western individualist focus.

A Professionalism Survey of Medical Students in Taiwan

Background Following the curriculum reforms of 2002 that emphasized humanistic values and ethics in medical education and instituted liberal arts requirements, medical students are expected to acquire a new conception of professionalism that incorporates the social contract inherent to the profession. Purpose This paper presents the results of a 2007 survey of medical students concerning their ideals. Methods The survey instrument was designed based on codes of conduct for good doctoring; it encompassed five dimensions deemed essential to professionalism. The quality of the instrument was assured via consultation with experts as well as with reliability and validity tests. The data were collected from 440 out of 860 first- to fourth-year undergraduate medical students at four medical schools between April and June 2007 in Taiwan. Statistical analysis utilized LISREL 8.72 to check construct validity. Further ANOVA tested the significance of differences among groups. Results The 440 responding medical students expressed a high valuation for all dimensions of medical professionalism; however, they placed relatively greater importance on medical knowledge and skills, interpersonal skills, and teamwork. First- and second-year students had a slightly higher valuation for all dimensions compared to fourth-year students. This may be due to curriculum reforms not being fully in effect when the older students began study. Conclusion Taiwan's humanistic medical educational reforms are only in the nascent stages, and subsequent longitudinal studies are recommended. The slight gap between general universities and medical universities may reflect a greater range of liberal arts courses in general universities that enhance a student's basic understanding of humanities. Nonetheless, liberal arts courses are now listed as requirements for undergraduate medical students.

Effects of the Emergency Trauma Training Course on the Confidence of Final-Year Medical Students Dealing with Trauma Patients

Trauma is an important issue that has been neglected in the training of medical students. This study evaluated the effects of the Emergency Trauma Training Course (ETTC), after completion of standard medical training, on seventh-year medical students. The ETTC was designed in Taiwan by the Taiwan Society of Emergency Medicine to train physicians and registered nurses who care for trauma patients in the emergency department (ED). We implemented the course for our medical students' internship. One hundred and fifty-one participants were divided into three groups: Group A included 36 medical students before they entered their internship in hospital; Group B included 41 medical students who had received 6 months of internship training in hospital; and Group C included 74 ED nurses. Group C was used to test Cronbach's alpha coefficient of the questionnaire. After the training course, the participants had a final examination and filled out a questionnaire about the training course and their levels of self-confidence. There were no differences in scores between the medical students in Groups A and B (p = 0.064). Using repeated measures analysis of variance, we found that confidence before training was low, with no difference between Groups A and B. Confidence improved after training, but there was still no significant difference between the groups (p = 0.875). However, there were significant differences between confidence levels before and after the training course (p < 0.001). Therefore, although inhospital training for 6 months failed to increase confidence, the confidence of final year medical students after completion of their training was improved by the ETTC. This indicates that the ETTC could increase the confidence of participants. This is the first evaluation of the implementation of the ETTC for final-year medical students in Taiwan. Based on our results, we highly recommend that this training course be taught to final-year medical students before they practice in hospital.

Cross-cultural medical education: Can patient-centered cultural competency training be effective in non-Western countries?

Background: No evidence addresses the effectiveness of patient-centered cultural competence training in non-Western settings.Aims: To examine whether a patient-centered cultural competency curriculum improves medical students’ skills in eliciting the patients’ perspective and exploring illness-related social factors.Method: Fifty-seven medical students in Taiwan were randomly assigned to either the control (n = 27) or one of two intervention groups: basic (n = 15) and extensive (n = 15). Both intervention groups received two 2-hour patient-centered cultural competency workshops. In addition, the extensive intervention group received a 2-hour practice session. The control group received no training.Results: At the end of the clerkship, all students were evaluated with an objective structured clinical examination (OSCE). Students in the extensive intervention group scored significantly higher than the basic intervention and control groups in eliciting the patient's perspective (F = 18.38, p < 0.001, η2 = 0.40). Scores of both intervention groups were significantly higher than the control group in the exploring social factors (F = 6.66, p = 0.003, η2 = 0.20).Conclusion: Patient-centered cultural competency training can produce improvement in medical students’ cross-cultural communication skills in non-Western settings, especially when adequate practice is provided.

Nutrition knowledge, attitudes and practices among senior medical students in Taiwan.

Nutrition is an important issue in medical training, but the nutritional knowledge, attitudes and practices of medical students in Taiwan have not been elucidated.This investigation was a need assessment that examined knowledge, attitude and practices of medical students in selected areas of nutrition. A national sample of 528 senior medical students from nine medical colleges in Taiwan participated in this study by completing a questionnaire.On a 10-point scale, the average score of students on general and clinical nutritional knowledge was 5.99 +/− 1.51 and 5.15 +/− 1.77, respectively. The percentage of correct answers from questionnaires in both areas was 60% and 52%, respectively. Seventy-seven percent or more of the students reported that they either agreed or strongly agreed with four positive-attitude statements and either disagreed or strongly disagreed with two out of three negative-attitude statements. Between 30% and 61% of the students reported that they practice on nutrition-related individual behaviors.The knowledge, attitudes and practices of senior medical students in Taiwan suggest the need for education strategies to improve competence in the area of nutrition.