Педагогические науки / 2. Проблемы подготовки специалистов

PhD, MD, Professor Koloskova O.K., PhD, Bilous T.M., PhD, Ortemenka Ye.P., PhD, Kchilchevska V.S.

Bukovinian State Medical University, Ukraine

THE EFFECTIVENESS OF LEARNING OF PEDIATRICS DURING UNDERGRADUATE AND POSTGRADUATE STAGES OF STUDYING IN UKRAINE

Background. A system of integrated license exam is currently the method of standardized determining of the level of professionalism of medical schools graduates, which has to correspond with a certain qualification level of educational and professional training program of specialists [1, 2]. Licensing exams include tests for the verification of a competence of students or interns and, as well, for identifying the quality of their knowledge in main areas of medicine. Test license exam (TLE) "Step 2" based on the training/educational program within the IV-VI courses of Medical school, is aimed at students’ ability to apply their knowledge to diagnose and determine management tactics with common diseases. At that, "Step 3" is designed for a variety of clinical areas and used as an integrated license exam at the end of the internship. Namely, interns take the "Step 3" examination during the internship, the duration of which depends on the chosen specialty and can last from one to three years. There are different, depending on the basic profiles (surgical, therapeutic, dental, etc.), versions of "Step 3" exam available in Ukraine. Exactly according to the results of the "Step 3" exam the ability of interns to use their knowledge of the differential diagnosis of diseases, the urgent aid as well as an organization of assistance to patients in a variety emergency, including extreme, situations can be determined [3]. However, for successful completion of this license exam, medical interns have to apply knowledge both undergraduate and postgraduate education, since in the booklets available questions not only about primary medical care and first aid, but also about specialized medical assistance to patients, that demanded the theoretical knowledge as well as the basic practical skills. However, it should be noted that the specialized training for upcoming specialty of medical interns plays a role in the effectiveness of education, namely, given the fact that interns a priori have to know more in their field than in others [4]. Proceeding from the above, analysis of the results of "Step 3" exam, written by medical interns of the various specialties, is promising for further intensification of educational and practical training as well as for final generation of qualitatively trained doctors.

Objective. Conduct a mathematical analysis of the results of "Step 3" exam passed by medical interns of different specialties.

Materials and methods. It has been analyzed the level of progress of 997 graduates throughout theirs studying in Bukovinian State Medical University. The analysis included average score, gained by students during practical classes, theirs scores for the final exam of Pediatrics, as well as the results of both licensing exams "Step 2" and "Step 3". The total cohort amounted to 314 students (31.5%) of Faculty №1 (“General practice”, the budgetary form of education), 459 graduates (46%) of Faculty №2 (“General practice”, studying under the contract) and 224 students (22.5%) of the Faculty №3 (Pediatrics). These survey results were analyzed by both parametric and nonparametric methods of calculation and the methods of clinical epidemiology, using the software package "STATISTICA 7.0" StatSoft Inc. and Excel XP for Windows on a PC.

Results and Discussions. Analysis of 5^th year student’s scores from Pediatrics has been showed that the best progress in studies got students of Faculty №1. Thus, the average score from the "Neonatology" was 3,6±0,04 points in Faculty №2 and 3,7±0,06 points in Faculty №3, while 4,0±0,05 points (p<0.05) in Faculty №1. A similar situation has been recorded from the science "Children oncology and hematology": the average score of 1 faculty reached up to 3,5±0,04 points in Faculty №2 and 3,7±0,05 points in Faculty №3, but 4,0±0,05 points (p<0.05) in Faculty №1. The level of studying advancement from the "Children pulmonology and allergology" was almost the same (3.5±0,04; 3.6±0,05 and 3.9±0,05 points (p<0.05) respectively.

On average the total score, that students got during classes, corresponded to theirs grades for individual work (writing the training case history), namely 3,6±0,05 points in Faculty №2 and 3,8±0,05 points in Faculty №3, but 4,1±0,05 points (p<0.05) in Faculty №1. The number of missed lectures (number per 1 student) during the academic year was the lowest in the Pediatric Faculty (3,3±0,4) and slightly higher (3,5±0,5) in students of medical Faculty №1, but the highest (5,8±0,5) in Faculty №2 (p<0.05). The positive trend of the attestation score for a month of training was the same at different Faculties (at the average 0.3 points), but the students of the Faculty №1 always had the highest score (3.8 points in September and 4.1 points in May), while the students of the Faculty №2 and the Faculty №2 had lower monthly score: (3.4 points in September and 3.7 points in May) and (3.6 points in September and 3.8 points in May) correspondingly. Thus, during the school year the best learning results have been showed by students of the budgetary form of education, and the worst – by students studying under the contract. This trend continued also during the final examination in Pediatrics, namely, the average exam score reached 3.9 points in Faculty №1, but 3.6 points in Faculty №2 and 3.7 points in Faculty №3.

The results of the test license exam, passed by a cohort of students included in the analysis, have been showed that the average percentage of correct answers was the highest and statistically probable, both in general and according to some subtest, in Pediatric Faculty (77.1%) in comparison with the data of Faculty №1 (73,8%) in Faculty №2 (69,3%). As well, the average percentage of correct answers for the subtest "Pediatrics" was the highest in the Pediatric Faculty (85.5%), which is significantly higher than the average indices of Faculty №1 (77%) and Faculty №2 (71.7%); (p<0.05).

Based on the result of a correlation analysis, it has been noted that the TLE "Step 2" score had the strongest connection with both the grades during the V-th courses of Medical school (R=0,4, р<0,0001) and the mark for writing the training case history (R=0,4, р<0,0001), as well as the number of missed lectures during the academic year (R=-0,4, р<0,01) and the attestation scores for the 8 months of training during the V-th courses (R=03-0,4, р<0,001).

Therefore, by an usage of the multifactor model we attempted to determine a significant factors, that would have a statistically proven effect on the results of "Step 2". In particular, we are presenting the results of a factor analysis of "Step 2" data in the total cohort of students:

The results of test license exam "Step 2"= 0,3 F1 + 0,2 F2 + 0,1 F3

At that, the likely reinforcing components of the first (F1) factor were outcomes in learning Pediatrics during the V-th courses of Medical school (scores for the different studied pediatric science as well as the final examination grade in Pediatrics). And at the same time, the second (F2) factor was significantly reinforced by the monthly attestation scores, but the third (F3) factor was strongly connected to the educational Faculty.

Thus, we can conclude that a form of getting education as well as a motivational element of studying in some way affects the results of the TLE "Step 2".

At the same time, it has been noted that despite the highest rates of "Step 2" results in Pediatric Faculty, the results of the TLE "Step 3" in Faculty №3 were significantly lower (80.5%) than in Faculty №1 (83.9%) and Faculty №2 (81%). It should be noted that the highest number of correct answers on "Step 3" tests of pediatric profile were given by students of Faculty №1 (85.7%) compared with results of Faculty №2 (83.5%) and Faculty №3 (83.5%).

At that, the results of the "Step 3" exam had a statistically significant correlation of the average force with the results of TLE "Step 2" (R=0,4, p<0.001), as well as with the grades during the V-th courses of Medical school (R=0.3, p<0.01). That is, the better prepared students had formed the cohort of better trained interns.

These results were confirmed by the results of the correlation multifactoral analysis. In particular, we are presenting the results of multifactorial analysis of "Step 3" results of the total cohort of interns:

The results of test license exam "Step 3"= 0,3 F1 + 0,2 F2 + 0,1 F3

At that, the likely reinforcing components of the first (F1) factor were grades for Pediatrics during the V-th courses of Medical school, but the second (F2) factor was significantly reinforced by the results of TLE "Step 2", while the third (F3) factor was strongly connected to characteristics of the Faculty of students’ education.

Conclusions. Thus, our statistical analysis of the training results of 997 students of the specialty "General Medicine" and "Pediatrics" for the past 3 years, has allowed performing following conclusions about the possibility of improving motivation of students and interns for studying:

1. Indices of the effectiveness of learning of pediatrics have influence on the results of test license exam "Step 2", that require increasing motivation to study pediatrics, and in particular to start preparing to this exam already in the 4^th-5^th courses of Medical School.

2. The form of students education (budgetary or under a contract) in some way affect the results of the TLE "Step 2".

3. Interns who had both higher grades during the V-th course of Medical School and high results of "Step 2" exam and, as well, received their education by the state-provided grants (budgetary form), have probably the best chances of successful writing test license exam "Step 3".

References.

1. Приказ МЗ Украины №762 от 20.11.2006 г. О внедрении лицензионного интегрированного экзамена «Шаг 3. Общая врачебная подготовка» как составной части государственной аттестации врачей-интернов.

2. Пидаев А.В., Передерий В.Г. Болонский процесс в Европе. - Одеса, 2004. - 192 с.

3. Крок 3.  Лечебное дело. Педиатрия / Г. Дзяк, Т. Перцева, В. Лехан [и др.] // Журнал современного врача. Исскуство лечения. - 2004. -№3. - С. 91-92.

4. Колоскова Е.К. Результаты тестового экзамена «Крок-3» как критерий качества подготовки врачей-интернов / Е.К. Колоскова, Т.М. Воротняк // І Всеукраинская научно-практическая интернет-конференция «Отечественная наука: современное состояние, актуальные проблемы и перспективы развития» (Переяслав-Хмельницкий, 29-31 октября 2011 г.). – Электр. сборник научных трудов. - С. 162-164.