Taiwanese Medical Students Research Articles

Negative effects on medical students' scores for clinical performance during the COVID-19 pandemic in Taiwan: a comparative study.

Coronavirus disease 2019 (COVID-19) has heavily impacted medical clinical education in Taiwan. Medical curricula have been altered to minimize exposure and limit transmission. This study investigated the effect of COVID-19 on Taiwanese medical students' clinical performance using online standardized evaluation systems and explored the factors influencing medical education during the pandemic. Medical students were scored from 0 to 100 based on their clinical performance from 1/1/2018 to 6/31/2021. The students were placed into pre-COVID-19 (before 2/1/2020) and midst-COVID-19 (on and after 2/1/2020) groups. Each group was further categorized into COVID-19-affected specialties (pulmonary, infectious, and emergency medicine) and other specialties. Generalized estimating equations (GEEs) were used to compare and examine the effects of relevant variables on student performance. In total, 16,944 clinical scores were obtained for COVID-19-affected specialties and other specialties. For the COVID-19-affected specialties, the midst-COVID-19 score (88.513.52) was significantly lower than the pre-COVID-19 score (90.143.55) (P<0.0001). For the other specialties, the midst-COVID-19 score (88.323.68) was also significantly lower than the pre-COVID-19 score (90.063.58) (P<0.0001). There were 1,322 students (837 males and 485 females). Male students had significantly lower scores than female students (89.333.68 vs. 89.993.66, P=0.0017). GEE analysis revealed that the COVID-19 pandemic (unstandardized beta coefficient=-1.99, standard error [SE]=0.13, P<0.0001), COVID-19-affected specialties (B=0.26, SE=0.11, P=0.0184), female students (B=1.10, SE=0.20, P<0.0001), and female attending physicians (B=-0.19, SE=0.08, P=0.0145) were independently associated with students' scores. COVID-19 negatively impacted medical students' clinical performance, regardless of their specialty. Female students outperformed male students, irrespective of the pandemic.

Medical students' perceptions of their preparedness to care for LGBT patients in Taiwan: Is medical education keeping up with social progress?

Integrating training on health equity of sexual and gender minorities (SGM) in medical education has been challenging globally despite emphasis on the need for medical students to develop competence to provide adequate care for diverse patient groups. This study elicits Taiwanese medical students' perceptions of their values and preparedness to care for Lesbian, Gay, Bisexual, or Transgender (LGBT) patients using a qualitative approach that considers broader societal changes, and more focused topics such as the provision of relevant training in medical education. Eighty-nine medical students/trainees from two southern Taiwanese medical schools (one public and one private) participated in focus groups (n = 70) and individual interviews (n = 19). Qualitative analysis was conducted using inductive thematic analysis. Participants (i) expressed wide social acceptance and openness toward LGBT individuals, but were unsure of ways to communicate with LGBT patients; (ii) confirmed that stigmatization and biases might be developed during their training; (iii) recognized gender stereotypes could have negative impacts on clinical reasoning; (iv) considered themselves prepared to care for LGBT patients, yet equated non-discriminatory attitudes to preparedness; (v) acknowledged a lack of relevant professional skills; (vi) implicated curriculum did not address LGBT issues systematically and explicitly. This study has identified the insufficiencies of current medical training and inadequate preparedness of medical students/trainees to provide better care for LGBT patients. It provides insights for medical educators to design and implement effective medical curriculum and training, and faculty development programs to equip medical students/trainees with self-awareness and competencies to more readily provide holistic care for SGM, in keeping up with social progress, and promote health equity for a more diverse patient population.

Effectiveness of innovative instructional module for professional competence in health literacy in medical students

BackgroundPhysicians should be equipped with professional competence in health literacy to communicate more effectively with patients with limited health literacy. However, the health literacy curriculum has not yet been refined globally, and is scarce in Taiwan’s medical education. We implemented an innovative instructional module to attain professional competence in health literacy among medical students and investigated its effects.MethodsWe adopted a quasi-experimental design and recruited 204 fifth-year Taiwanese medical students between December 2019 and May 2020. Participants who worked as clerks at the Department of Family Medicine of three medical schools in northern Taiwan were assigned to the experimental group through convenience sampling. A total of 98 students received a three-hour innovative instruction, including medical simulation videos, role-playing, and board games. Both the experimental and control groups completed the online pre-test and mail-in post-test. A generalized estimating equation was applied to measure the effects of the intervention.ResultsThere was a significant difference between the experimental and control groups in terms of professional competence in health literacy in all three aspects. In terms of knowledge, the experimental group improved 12% more than the control group (\U0001d6fd=0.12, 95% CI: 0.05 ~ 0.19, p = 0.001). In terms of attitude, the experimental group improved by an average of 0.27 more points per question than the control group (\U0001d6fd=0.27, 95% CI: 0.08 ~ 0.46, p = 0.007). As for skill, the experimental group improved by an average of 0.35 more points per question than the control group (\U0001d6fd=0.35, 95% CI: 0.14 ~ 0.55, p = 0.001).ConclusionThe proposed innovative instructional module significantly improved fifth-year medical students’ professional competence in health literacy, which is expected to benefit their future medical practices.

Scaffolding to Equip Taiwanese Medical Students with Fundamental Skills for Spoken English

This qualitative study aimed to investigate if a flipped classroom, activity-based approach could help equip tertiary Taiwanese medical students with fundamental English conversation abilities to prepare them for their future career. Relying on Vygotskian socio cultural conceptual framework, learning to accomplish an activity with scaffolding can help one internalize or acquire the targeted language skills, required to achieve fluent spoken English abilities. The participants of this research were twenty-two freshman medical students from the required freshman English conversation class at a university in southern Taiwan. The data sets included (1) pre-course questionnaire, (2) journal writing, (3) scripts of two informed speech, (4) two oral reports, (5) semi-structured interviews, and (6) field notes based on class observations. To cope with the common problems, found in today’s classroom in Taiwan, from students’ increasing range of individual differences, inactive students, time limit, frequent large class size, and limited opportunities for students to practice the targeted language skills, the findings suggested that this flipped classroom, strategy-based approach provided students obvious assistance to accomplish informed speeches.

A mixed-methods study of English vocabulary for medical purposes: medical students’ needs, difficulties, and strategies

AbstractThis mixed-methods study investigated the English medical vocabulary strategies, needs, and difficulties of Taiwanese medical school students via an open- and closed-ended questionnaire (n = 17), a test measuring vocabulary size (n = 17), student interviews (n = 5), and teacher interviews (n = 3). Students reported using some vocabulary strategies more than others. A statistically significant negative relationship between students’ English vocabulary size and their use of word cards for vocabulary learning was also revealed. Through analysis of the interview data gathered from the medical students and their English teachers, five vocabulary learning difficulties faced by the medical students were uncovered: (1) nonexistent intentional English vocabulary learning, (2) stagnant specialized medical English vocabulary acquisition, (3) lack of sufficient contextualized academic English writing practice with newly encountered specialized medical vocabulary; (4) lack of teacher feedback on the students’ vocabulary use; and (5) lack of pedagogical communication among faculty. The pedagogical implications of these results were discussed with a focus on improving students’ vocabulary learning efficiency in light of their specialized English medical vocabulary needs.

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.

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.

EFL medical students’ metacognitive strategy use for hypertext reading comprehension

The ability to read English efficiently and effectively is important for medical students because they have to read a lot of medical texts published in English. This is challenging especially for non-native speakers. This study measures Taiwanese medical students’ self-perceived use of metacognitive strategies while reading printed texts and hypertexts, and also the potential impact of hypertext on English reading comprehension. The results of the study showed that the strategies used the most by the printed text and hypertext groups were problem-solving strategies, followed by global strategies; whereas support strategies were least used. Learners in the printed text group reported more strategy use of reading slowly and using background information than the learners in the hypertext environment. A significant reading improvement and positive correlations were found between the strategies of guessing content, checking guesses, and guessing unknown words on hypertext comprehension enhancement. Such results suggested that the majority of students frequently used the three specific strategies and the degree of such strategy uses was reliably predicted by their comprehension scores. Based on the investigation results, limitations and future research are discussed and presented.

Taiwanese medical students' narratives of intercultural professionalism dilemmas: exploring tensions between Western medicine and Taiwanese culture.

In an era of globalization, cultural competence is necessary for the provision of quality healthcare. Although this topic has been well explored in non-Western cultures within Western contexts, the authors explore how Taiwanese medical students trained in Western medicine address intercultural professionalism dilemmas related to tensions between Western medicine and Taiwanese culture. A narrative interview method was employed with 64 Taiwanese medical students to collect narratives of professionalism dilemmas. Noting the prominence of culture in students' narratives, we explored this theme further using secondary analysis, identifying tensions between Western medicine and Taiwanese culture and categorizing students' intercultural professionalism dilemmas according to Friedman and Berthoin Antal's 'intercultural competence' framework: involving combinations of advocacy (i.e., championing one's own culture) and inquiry (i.e., exploring one's own and others' cultures). One or more intercultural dilemmas were identified in nearly half of students' professionalism dilemma narratives. Qualitative themes included: family relations, local policy, end-of-life care, traditional medicine, gender relations and Taiwanese language. Of the 62 narratives with sufficient detail for further analysis, the majority demonstrated the 'suboptimal' low advocacy/low inquiry approach (i.e., withdrawal or inaction), while very few demonstrated the 'ideal' high advocacy/high inquiry approach (i.e., generating mutual understanding, so 'intercultural competence'). Though nearly half of students' professionalism narratives concerned intercultural dilemmas, most narratives represented disengagement from intercultural dilemmas, highlighting a possible need for more attention on intercultural competence training in Taiwan. The advocacy/inquiry framework may help educators to address similar disconnects between Western medicine and non-Western cultures in other contexts.

Action Research: Applying a Bilingual Parallel Corpus Collocational Concordancer to Taiwanese Medical School EFL Academic Writing

Lack of knowledge in the conventional usage of collocations in one’s respective field of expertise cause Taiwanese students to produce academic writing that is markedly different than more competent writing. This is because Taiwanese students are first and foremost English as a Foreign language (EFL) readers and may have difficulties picking up on the regularly encountered patterns of collocating words found in texts, since nothing on the page highlights collocations as such. As one step in determining a solution to this problem, this paper reports on action research that took place in an EFL writing classroom where undergraduate Taiwanese medical students (n = 25) were encouraged to self-edit their academic writing for verb-noun collocation errors through the use of a web-based English/Chinese bilingual parallel corpus collocational concordancer. Statistical analysis of students’ drafts revealed the use of the collocational concordancer resulted in verb-noun collocation accuracy increasing steadily with each subsequent draft for two essay types (i.e. descriptive and opinion). However, qualitative analysis of student feedback regarding their experience in using the collocational concordancer to self-edit their academic writing showed a difference in acceptance and success. Furthermore, students expressed negativity towards the EFL writing teacher requesting students to self-edit academic writing. The collocational concordancer functions, nuanced statistical results in terms of collocation accuracy, and pedagogical implications of the action research results are discussed.

Cross-Cultural Construct Validity Study of Professionalism of Vietnamese Medical Students

Background: Although many studies have made efforts to define and assess medical professionalism, few have addressed issues of construct validity. Purposes: The purpose of this article is to explore further construct validity of medical professionalism employing exploratory and confirmatory factor analysis. Methods: The 32-item instrument by the American Board of Internal Medicine (ABIM) was adapted to assess the perceptions on medical professionalism of Vietnamese medical students. A sample of 1,196 (487 first-year, 341 third-year, 368 sixth-year) medical students participated voluntarily in the completion of the instrument. The data were randomly divided into three samples to assess the construct validity of medical professionalism by empirically deriving and confirming a model of professionalism. Results: Exploratory and confirmatory factor analytic techniques resulted in a six-factor well-fitting model with a comparative fit index of .963 and root mean square error approximation of .029, 90% confidence interval [016, .039]: integrity, social responsibility, professional practice habits, ensuring quality care, altruism, and self-awareness. Social responsibility was perceived least important, and self-awareness was perceived most important by Vietnamese medical students. These constructs of medical professionalism were relatively similar with those found in Taiwanese medical students and the ABIM definitions but with some Vietnamese cultural differences. Conclusions: Although the results confirm that medical professionalism is a somewhat culturally sensitive construct, it nonetheless has many elements of medical professionalism that are universal. Future research should be conducted to test the generalizability of our six-factor model of professionalism with various samples (e.g., residents, physicians), cultures, and language groups.

Learning to listen: Effects of using conversational transcripts to help medical students improve their use of open questions in soliciting patient problems

ObjectiveThis study reports effects of a ‘bottom-up’ pedagogy using doctor–patient conversation transcripts to improve medical students’ use of open questions in soliciting patient problems. MethodsWe implemented an innovative approach involving students reviewing transcripts of medical interviews, skills practice using role-play and standardized patients (SPs), and reflection on these practices. We analyzed three open question categories (general, biomedical, and psychosocial) used by 27 Taiwanese medical students from two SP interviews, conducted before and after training. ResultsAcross the full encounter, use of general and psychosocial open questions increased significantly after training (from 27 to 92 general questions and 15 to 33 psychosocial questions). The high rates of narrowly focused opening questions (52% of initial position questions, 74% of second position questions, and 85% of third position questions) prior to training were reduced to 11%, 15%, and 15% respectively after training. Students also shifted from a micro (narrow) to a macro (broad) pattern of questioning. ConclusionThe ‘bottom-up’ approach facilitated by using conversation transcripts is effective in improving communication skills. Practice implicationsBy carefully reviewing transcripts of their own performance as part of an overall communication training package, beginning medical students can become more patient-centered in soliciting patient problems.

Rhetorical structure and linguistic features of case presentations in case reports in Taiwanese and international medical journals

The case presentation is the core section of a medical case report. Issues in the teaching of case report writing have recently been the subject of great interest in medical education, especially in the era of globalization. Given that Taiwanese medical students, residents and junior physicians are requested to write case reports in English and they may experience difficulty in language use, there is a need to investigate models. The purpose of this study is to identify the rhetorical structure of case presentations and to find the differences in the linguistic features of case presentations between international and Taiwanese medical journals. We conducted a hand-tagged move analysis of a corpus of 40 case presentations. The findings revealed that the rhetorical structure of case presentations is similar. However, differences emerged in the analysis of the linguistic features showing chronological order and the record of admission and these were perceived as the two major drawbacks in Taiwanese presentations. For medical and English teachers, these findings can be easily transformed into teaching materials. This study contributes to a model of interdisciplinary collaboration among professionals in English for Medical Purposes (EMP) and Medicine on college teaching and training of medical English writing.

Michael Shiyung Liu, Prescribing Colonization: The Role of Medical Practices and Policies in Japan-Ruled Taiwan, 1895–1945, Asia Past &amp; Present: New Research from AAS (Ann Arbor, MI: Association for Asian Studies, 2009), pp. x + 286, $25.00, paperback, ISBN: 978-0-924304-57-6.

Michael Shiyung Liu, Prescribing Colonization: The Role of Medical Practices and Policies in Japan-Ruled Taiwan, 1895–1945, Asia Past &amp; Present: New Research from AAS (Ann Arbor, MI: Association for Asian Studies, 2009), pp. x + 286, $25.00, paperback, ISBN: 978-0-924304-57-6.

Performance Anxiety at English PBL Groups Among Taiwanese Medical Students: A Preliminary Study

Students' performance anxiety can impact negatively on the effectiveness of medical education reform, including performance in problem-based learning (PBL) and in using English in discussion. This study aimed to investigate the nature of performance anxiety among Taiwanese medical students in an English-language PBL group. Eighteen Taiwanese, one American and four Asian medical students who were attending an international PBL workshop were enrolled. A questionnaire seeking demographic data and experience in use of PBL and eight questions evaluating performance anxiety were administered. The performance anxiety of Taiwanese medical students was compared to that of the Asians and the one American. Frequencies of each performance anxiety were calculated. The results suggested that the Taiwanese students showed more anxiety than the one student from the United States, but less than other Asian students. The acts of giving a report, being the center of attention, and talking in the PBL group were the most common situations related to anxiety in PBL groups. Using English and working in a new PBL environment are possible sources of anxiety. The presence of anxiety among the Taiwanese medical students in English PBL groups implies the necessity for developing an effective strategy to deal with students' performance anxiety.

Comment on ‘A PAX6 gene polymorphism is associated with genetic predisposition to extreme myopia’

Sir, Tsai et al1 carried out a case–control association study in 340 Taiwanese medical students, and reported an association between presence of ‘extreme myopia’ ( 80%, it would have to exert a strong selective advantage. No such advantage has been attributed to the C allele of rs667773. Finally, unless the genetic risk factors for high and extreme myopia are distinct, the lack of association with high myopia is unexpected, especially since power was greater to detect an association with high myopia than extreme myopia.

A Study on the Personal Traits and Knowledge Base of Taiwanese Medical Students Following Problem-based Learning Instructions

Introduction: Problem-based learning (PBL), a pedagogic concept using a student-centred approach and problem-solving through small group discussions, has been adopted in varying degrees for years at all 11 medical institutes in Taiwan. Much evidence has shown that a number of factors can seriously affect student performance in PBL courses, such as the design of PBL scenarios, the tutors’ character and students’ attitudes and efforts. Materials and Methods: The aim of this study was to examine how the personal characters or knowledge base of Taiwanese medical students influence their performance in a hybrid-PBL curriculum. A total of 309 (234 male, 75 female) high-school entry undergraduate medical students participated in this survey. Self-assessed personal traits were presented in a 44-item questionnaire with a Big Five factor structure. Knowledge base was assessed by students’ score point average (SPA) based on their previous 4-year education in medical school. Peer-assessed performance of students in the PBL curriculum was carried out using a well-developed, reliable and validated evaluation form. Results: Each student’s peer-evaluated PBL performance can be divided into 5 principal components, which included control-lead, assist-coordinate, written organisation and compromise-comply (Eigen value &gt;1). The consistency and reliability of the Big Five questionnaire on personal traits was analysed and discordant items were deleted (Cronbach’s alpha = 0.72 to 0.86 after deletion). The relationship between the personal traits, knowledge base and PBL performance, as analysed by simple regression, showed that “extraversion” and “openness to experience” were positively related to the “assist-coordinate” characteristic in PBL performance, and “conscientiousness” was positively related to the “control-lead” characteristic in PBL performance. The SPA was positively related to the “assist-coordinate” or “control-lead” characteristic in PBL performance. The “agreeableness” was negatively correlated with the “control-lead” characteristic in PBL performance. After stepwise regression between the Big Five and each component of PBL performance, only the correlation between conscientiousness and control/lead, and between extraversion and assist/coordinate remained significant. Conclusion: Knowledge and personality characteristics appear to be associated with student performance in a hybrid-PBL curriculum. The implications of this study on the future development and application of this assessment tool in medical schools are presented. Key words: Big-Five, Performance, Score point average

Attitudes, Concerns, and Knowledge of Taiwanese Medical Laboratory Technologists and Students Regarding HIV and AIDS

Attitudes, Concerns, and Knowledge of Taiwanese Medical Laboratory Technologists and Students Regarding HIV and AIDS

Acquired immune deficiency syndrome and human immunodeficiency virus: Taiwanese medical laboratory technologists and students’ attitudes, concerns and knowledge

Acquired immune deficiency syndrome and human immunodeficiency virus: Taiwanese medical laboratory technologists and students’ attitudes, concerns and knowledge

Between Ethnicity and Modernity: Taiwanese Medical Students and Doctors Under Japan's Kōminka Campaign, 1937–1945

Between Ethnicity and Modernity: Taiwanese Medical Students and Doctors Under Japan's <i>Kōminka</i> Campaign, 1937–1945