Pilot application and Comparative Study between inter-raters in Clinical Performance Examination (CPX) of Ankle Sprain

Minjeong Kim; Kim, Minjeong

doi:10.13048/jkm.24042

JKM > Volume 45(3); 2024 > Article

Kim: Pilot application and Comparative Study between inter-raters in Clinical Performance Examination (CPX) of Ankle Sprain

Original Article

The Journal of Korean Medicine 2024; 45(3): 112-121.

Published online: September 1, 2024

DOI: https://doi.org/10.13048/jkm.24042

Pilot application and Comparative Study between inter-raters in Clinical Performance Examination (CPX) of Ankle Sprain

Minjeong Kim

Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Sangji University

Correspondence to: Minjeong Kim, Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Sangji University, 83 Sangjidae-ro, Wonju, Gangwon-do, 26338, Republic of Korea, Tel: +82-33-741-9289, Fax: +82-33-741-9141, E-mail: goodykmj@hanmail.net

Received July 15, 2024 Revised August 18, 2024 Accepted August 23, 2024

Abstract

Objectives

The purpose of this study is to analyze the evaluation results and score deviation between interraters after performing ankle sprain CPX.

Methods

Ankle sprain CPX was performed on fourth-year students in the Department of Korean Medicine. A student standardized patient(SSP) filled out the 50-point PPI questionnaire.

Results

Ankle sprain CPX final score was 28.20 ± 1.40. Evaluation items showed low scores in the following order: performance time, physical examination, and past and social history check. The “physical examination” accounted for the largest proportion of the score deviation between interraters. In PPI, the lowest score was “effective questioning”, and the highest scores were “listening” and “empathy”.

Conclusions

We hope that follow-up research will be conducted to develop objective and reliable CPX evaluation standards and scoring checklists in the future.

Keywords: Ankle Sprain, Clinical performance examination, Patient-physician interaction, Korean medical education

Fig. 1

History taking in ankle sprain CPX

Fig. 2

Measuring ankle circumference in ankle sprain CPX

Table 1

General characteristics of study subjects

Characteristics	Subgroups	n (%)	Total
Sex	Male	23 (54.8)	42
Sex	Female	19 (45.2)	42

Age	20–29 yrs	40 (95.24)	42
	30–39 yrs	2 (4.8)
	≥40 yrs	0 (0.0)

Table 2

Result of ankle sprain CPX and inter-rater variations (Details)

Classification	Details	Score	Mean±SD	Inter-rater Variation Occurrence(n)
Attitude	Self-introduction and patient confirmation	1	1±0	0

History Taking	Chief complaint	1	1±0	0
History Taking	Check onset	1	1±0	0

Attitude	Empathize	1	0.91±0.27	1

History Taking	Present illness	1	0.93±0.24	1
	Cause of onset	1	0.91±0.28	3
	Rating pain intensity (NRS)	1	0.97±0.16	3
	Chronic instability	1	0.96±0.18	1
	Past and social history	1	0.78±0.41	4
	Review of systems	1	0.97±0.14	0

Attitude	Pulse and tongue diagnosis	1	0.94±0.22	4
	Inspection description and consent	1	0.97±0.14	3
	Hand sanitization	1	0.83±0.36	7

Physical Examination	Inspection(gait)	1	0.97±0.16	0
	Inspection(bruise and edema)	1	0.99±0.08	1
	Diagnosis of the exclusion of a fractures and palpation of damaged ligaments	2	1.69±0.46	6
	Measurement of ankle circumference	2	1.19±0.27	1
	Check the range of motion of the ankle(dorsi flexion/extension)	2	1.80±0.39	14
	Check for ankle ligament instability(anterior drawer test/posterior drawer test /talar tilt test)	3	2.55±0.67	12

Patient Education	Description of test results and diagnosis	1	1±0	0
	Prognosis Description	1	1±0	0
	Treatment plan	1	0.95±0.20	1
	Management of lifestyle and exercise	1	1±0	0

Attitude	Open-ended questions and answers	1	0.97±0.16	0

Execution Time	Within 10 minutes	1	0.81±0.38	2

Total score		30	28.20±1.40

Table 3

Result of ankle sprain CPX and inter-rater variations (Main category)

Classification	Score	Mean	Achievement rate (%)	Inter-rater Variation Occurrence (Percentage%)
Attitude	6	5.69	94.87	15(19.48)
History Taking	8	7.58	94.81	12(15.58)
Physical Examination	11	10.12	92.07	47(61.03)
Patient Education	4	3.96	99.03	1(1.29)
Execution Time (10 min)	1	0.83	83.33	2(2.59)
Total	30	28.20	100	77(100)

Table 4

Results of PPI questionnaire

Num	Item	Score	Mean	S.D.	p-value
1	The doctor asked questions effectively.	10	9.52	1.08	0.10^*
2	The doctor listened to me carefully.	10	9.83	0.58	0.10^*
3	The doctor tried to understand my position.	10	9.83	0.62	0.11^†
4	The doctor explained things in an easy-to-understand manner for the patient.	10	9.71	0.74	0.35^‡
5	The doctor tried to build a good rapport with me.	10	9.76	0.90	0.29^$
Total		50	48.86	3.22

* 1 vs 2,

† 3 vs 1,

‡ 4 vs 1,

$ 5 vs 1

Appendices

Appendix 1

발목 염좌 CPX 평가 기준표

Appendix 2

Patient-Physician Interaction(PPI)

참고문헌

1. Park W. B., Shin J. S.2009. 일개 대학병 원의 내과학생 술기실습 현황. The Korean Journal of Medicine. 76:4. 451Retrieved from https://kiss.kstudy.com/ExternalLink/Ar?key=2769967

2. Jo H., Roh J., Sung H. K., & Park J.(2020). 학생표준화환자를 사용한 한의과대학 진료수행 시험 (cpx) 에 대한 학생 인식 조사. 대한예방한의 학회지;24(3):1-13. doi: 10.25153/spkom.2020.24.3.001

5. Jo H., & Min S.The current status and future operations of clinical performance evaluation (CPX) in the nationwide colleges (graduate schools) of traditional korean medicine. doi: 10.15521/jkmh.2020.33.2.009

7. Cho E., Leem J., Shin J., Go Y., & Song C.Presentation on research trends and suggestion for further research and education on objective structured clinical examination and clinical performance examination in korean medicine education. Scoping review;doi: 10.25153/spkom.2022.26.2.008

8. Kweon J. H., Sim S. B., Kim E. J., Hong J. W., & Shin S. W.(2018). Evaluation of the implementation of clinical performance examination in korean medicine education. Journal of Physiology & Pathology in Korean Medicine;32(1):51doi: 10.15188/kjopp.2018.02.32.1.51

9. Jo H., Jo N., Roh J., & Park J.(2021). 연극 인표준화환자와 학생표준화환자를 사용한 일개 한의과대학 진료수행시험 (cpx) 에 대한 임상실습 학생 인식 조사. 대한예방한의학회지;25(3):101-115. doi: 10.25153/spkom.2021.25.3.008

10. Yang S., Park K., & Cho S.한방부인과학에 서 임상실습교육의 만족도와 관련요인 분석;doi: 10.15204/jkobgy.2020.33.1.116

11. Kim B. N. R.(2020). 한방소아과학에서 임상 실습 교육의 만족도와 유용성 조사. 대한한방소 아과학회지;34(4):1-10. doi: 10.7778/jpkm.2020.34.4.1

12. Cho H., Hwang E., Shin B., Sul J., Hong J., Shin S., & Shin M.(2012). 임상실습교육의 만 족도와 관련요인 분석 - 한방재활의학을 중심으로. 대한예방한의학회지;16(2):1-15. doi: 10.25153/spkom.2024.28.1.004

13. Han C., Kang D., Park J., Kim B., Kim K., Kim Y., & Nam H.(2020). 한의과대학 실습 만족도 조사 - 의사-환자 역할극, 모의 cpx를 중 심으로. 韓方眼耳鼻咽喉皮膚科學會誌;33(1):12-24. doi: 10.6114/jkood.2020.33.1.012

14. Jo H., Park J., & Jo N.Survey of student satisfaction after role play using syndrome differentiation-based clinical performance examination scenario in class of korean medical classics. doi: 10.25153/spkom.2022.26.3.007

15. Jo H., & Jo N.(2020). 한의학 교육에서 內傷發熱 증례를 이용한 표준화환자 프로그램 개발 연구. 대한한의학원전학회지;33(4):33-56. doi: 10.14369/jkmc.2020.33.4.033

16. Park K., Cho S., Yang S., Shin H., & Choi Y.(2019). 표준화 갱년기장애환자를 활용한 한 의대생의 진료 및 의사소통 수준연구. 大韓韓方婦人科學會誌;32(2):100-118. doi: 10.15204/jkobgy.2019.32.2.100

17. An H., Yang S., Shin H., & Lee Hye-Yoon(2014). 표준화 난임환자를 활용한 한의대생의 진료 및 의사소통 수준연구. 대한예방한의학회지;18(3):1-10. doi: 10.25153/spkom.2024.28.1.004

18. Cho C. S.(2015). Student satisfaction study and interrater comparative study on patient-physician interaction score of clinical performance examination in korean medical education. Korean Journal of Oriental Physiology & Pathology;29(2):doi: 10.15188/kjopp.2015.04.29.2.152

19. Kim K., Kim H., An H., Shin H.2013. 표준화 화병환자를 활용한 한의대생의 진료 및 의사소통 수준연구. 대한예방한의학회지. 17:1. 163-179. Retrieved from http://click.ndsl.kr/servlet/LinkingDetailView?cn=JAKO201317642690851&dbt=JAKO&org_code=O481&site_code=SS1481&service_code=01

20. Jo H., Jo N., & Park J.(2022). 변증(辨證) 기 반 진료수행시험 (cpx) 시나리오를 이용한 역할극 에 대한 학생 자가 평가의 일치도와 개선 방안. 대한예방한의학회지;26(2):37-53. doi: 10.25153/spkom.2022.26.2.004

25. Cho E., Jung H., Leem J.2022. 한의학 전공학생의 진료 및 의사소통 역량 향상을 위한 동료 역할극 모델제안과 사례분석. Journal of Korean Medicine. 43:3. 49-64. Retrieved from https://www.dbpia.co.kr/journal/articleDetail?nodeId=NODE11138286

26. Shin J., Cho E., Leem J., Go Y., & Song C.Presentation on research trends and suggestion for further research and education on objective structured clinical examination and clinical performance examination in korean medicine education. Scoping review;doi: 10.25153/spkom.2022.26.2.008

27. 인창식 박정재, 유재환, &. 2021. 한의학교육프 로그램 2019년 역량중심 학습목표에 대한 술기 중심 분석 : 한의사 1차진료 역량의 주요 내용은 침구, 추나, 한약. 고등교육. 1-20. Retrieved from https://scholar.kyobobook.co.kr/article/detail/4040053522720

28. Kim S., Park S., Hur Y., & Lee S.(2005). The appropriateness of using standardized patients' (SPs) assessment scores in clinical performance examination (CPX). Korean Journal of Medical Education;17(2):163-172. doi: 10.3946/kjme.2005.17.2.163

29. Jun K. A., & Shin S. Y.(2011). Analysis of first clinical skills examination in the korean medical licensing examination: Focus on examinees' experience in a medical school. Korean Journal of Medical Education;23(3):203doi: 10.3946/kjme.2011.23.3.203