Creating Clinical Reasoning Assessment Tools in Different Languages: Adaptation of the Pediatric Emergency Medicine Script Concordance Test to Japanese
Abstract:Introduction: Clinical reasoning is a crucial skill in the practice of pediatric emergency medicine and a vital element of the various competencies achieved during the clinical training of resident doctors. Pediatric emergency physicians are often required to stabilize patients and make correct diagnoses with limited clinical information, time and resources. The Pediatric Emergency Medicine Script Concordance Test (PEM-SCT) has been developed specifically for assessing physician's reasoning skills in the conte… Show more
“…Finally, we evaluated only one subjective variable (i.e., emotions) based on the self-reported questionnaire; thus, a reporting bias could have affected the results. Therefore, other objective measurements, such as clinical reasoning performance tests, are needed in pediatrics [28]. In addition, the data on emotions were collected at one point of the study, and long-term psychological outcomes such as wellness remain uncertain [29].…”
The coronavirus disease 2019 (COVID-19) pandemic has challenged the feasibility of traditional in-person simulation-based clinical training due to the public health recommendation on social distancing. During the pandemic, telesimulation training was implemented to avoid multiple students and faculties gathering in confined spaces. While medical trainees’ perceived emotions have been acknowledged as a critical outcome of the in-person simulation-based training, the impact of telesimulation on trainees’ emotions has been unexamined. We conducted an educational team-based simulation study with a pediatric case of septic shock. Seventeen and twenty-four medical students participated in the telesimulation training and in-person simulation training, respectively. The institutional pandemic social restrictions at the time of each training session determined the participant assignment to either the telesimulation training or in-person simulation training. All participants responded to the Japanese version of the Medical Emotion Scale, which includes 20 items rated on a five-point Likert-type scale before, during, and after the simulation sessions. The measured emotions were categized into four emotion groups according to two dimensions: positive or negative and activating or deactivating emotions. The one-way analysis of variance between the telesimulation and in-person simulation training revealed no significant differences in the emotions perceived by the participants before, during, and after the simulation training sessions. The perceived emotions of medical students were comparable between the telesimulation and in-person simulation training. Further longitudinal studies with larger samples and multiple variables are needed to generalize the effectiveness of telesimulation.
“…Finally, we evaluated only one subjective variable (i.e., emotions) based on the self-reported questionnaire; thus, a reporting bias could have affected the results. Therefore, other objective measurements, such as clinical reasoning performance tests, are needed in pediatrics [28]. In addition, the data on emotions were collected at one point of the study, and long-term psychological outcomes such as wellness remain uncertain [29].…”
The coronavirus disease 2019 (COVID-19) pandemic has challenged the feasibility of traditional in-person simulation-based clinical training due to the public health recommendation on social distancing. During the pandemic, telesimulation training was implemented to avoid multiple students and faculties gathering in confined spaces. While medical trainees’ perceived emotions have been acknowledged as a critical outcome of the in-person simulation-based training, the impact of telesimulation on trainees’ emotions has been unexamined. We conducted an educational team-based simulation study with a pediatric case of septic shock. Seventeen and twenty-four medical students participated in the telesimulation training and in-person simulation training, respectively. The institutional pandemic social restrictions at the time of each training session determined the participant assignment to either the telesimulation training or in-person simulation training. All participants responded to the Japanese version of the Medical Emotion Scale, which includes 20 items rated on a five-point Likert-type scale before, during, and after the simulation sessions. The measured emotions were categized into four emotion groups according to two dimensions: positive or negative and activating or deactivating emotions. The one-way analysis of variance between the telesimulation and in-person simulation training revealed no significant differences in the emotions perceived by the participants before, during, and after the simulation training sessions. The perceived emotions of medical students were comparable between the telesimulation and in-person simulation training. Further longitudinal studies with larger samples and multiple variables are needed to generalize the effectiveness of telesimulation.
“…2 ) according to the valence (positive/negative) and activation (active/deactive) of the emotions: (a) positively activating (e.g., happiness, hope); (b) positively deactivating (e.g., relaxed, relieved); (c) negatively activating (e.g., anger, shame), (d) negatively deactivating (e.g., sadness, boredom), and neutral (i.e., surprise). The perceived level of difficulty of the PBL scenario was assessed using a 10-point Likert scale, and post-task self-efficacy for clinical reasoning was assessed using a 100-point Likert scale with 10-point intervals [ 14 , 16 ]. Fig.…”
Background
The effectiveness of peer learning has been recognized and discussed by many scholars, and implemented in the formal curriculums of medical schools internationally. However, there is a general dearth of studies in measuring the objective outcomes in learning.
Methods
We investigated the objective effect of near-peer learning on tutee’s emotions and its equivalence within the formal curriculum of a clinical reasoning Problem Based Learning session in a Japanese medical school. Fourth-year medical students were assigned to the group tutored by 6th-year students or by faculties. The positive activating emotion, positive deactivating emotion, negative activating emotion, negative deactivating emotion, Neutral emotion were measured using the Japanese version of the Medical Emotion Scale (J-MES), and self-efficacy scores were also assessed. We calculated the mean differences of these variables between the faculty and the peer tutor groups and were statistically analyzed the equivalence of these scores. The equivalence margin was defined as a score of 0.4 for J-MES and 10.0 for the self-efficacy score, respectively.
Results
Of the 143 eligible participant students, 90 were allocated to the peer tutor group and 53 were allocated to the faculty group. There was no significant difference between the groups. The 95% confidence interval of the mean score difference for positive activating emotions (–0.22 to 0.15), positive deactivating emotions (–0.35 to 0.18), negative activating emotions (–0.20 to 0.22), negative deactivating emotions (–0.20 to 0.23), and self-efficacy (–6.83 to 5.04) were withing the predetermined equivalence margins for emotion scores, meaning that equivalence was confirmed for these variables.
Conclusions
Emotional outcomes were equivalent between near-peer PBL sessions and faculty-led sessions. This comparative measurement of the emotional outcomes in near-peer learning contributes to understanding PBL in the field of medical education.
“…According to Kane [14], the validation of a measurement method requires gathering evidence to examine the four key inferences: (1) the scoring of a single observation (scoring), (2) using the primary observation score to generate the whole test performance (generalization), (3) inferring the real-life performance from the test performance (extrapolation), and (4) interpreting this information to make a decision (implication). In addition, recent validation studies in health sciences education have commonly used Kane's framework for translating psychomimetic tools in English into other languages [15,16].…”
Section: The Theoretical Framework Of Validationmentioning
The COVID-19 pandemic has greatly changed learning modalities in the teaching and learning of pediatric emergency medicine, and medical trainees’ self-regulation has become more emphasized. In Japan, the concept of self-regulated learning has not been fully applied in health profession education due to a lack of effective measurement tools. We aimed to validate the translated Japanese version of the Motivated Strategies for Learning Questionnaire in the context of Problem-Based Learning (J-MSLQ-PBL). The questionnaire employs a seven-point Likert-type scale with 81 items and is categorized into two sections: motivation and learning strategies. An exploratory factor analysis (EFA) was conducted by using Promax rotation to examine the factor structure of the scale, using the collected data from 112 Japanese medical students. Factor extraction was based on a scree plot investigation, and an item was accepted when the factor loading was ≥0.40. In the motivation section, the extracted factors from the EFA were well aligned with the subscales of the original MSLQ, including “Self-Efficacy for Learning and Performance”, “Task Value”, “Self-Efficacy for Learning and Performance”, “Test Anxiety”, “Extrinsic Goal Orientation”, and “Intrinsic Goal Orientation”. In the learning strategies, the extracted factors poorly matched the structure of the original subscales. This discrepancy could be explained by insufficient translation, the limited sample size from a single medical school, or cross-cultural differences in learning strategies between Western and Japanese medical students. Only the motivation part of the J-MSLQ-PBL should be implemented to measure the competency elements of self-regulated learning in Japan.
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