Journal of Education and Health Promotion

Abstract BACKGROUND: Role of multimedia training materials on Mini-CEX scores of internal medicine
residents. We aimed to assess the effect of multi multimedia training materials on Mini-CEX scores
of internal medicine residents of Isfahan University of Medical Sciences.
SETTINGS AND DESIGN: A quasi-experimental action research study on 1st, 2nd, and 3rd-year
internal medicine residents were implemented.
MATERIALS AND METHODS: The Mini-CEX test measures students’ performance in six core skills
necessary for medical practice. Mini-CEX scores of 135 internal medicine residents in 2017–2018
were compared before and after the training with prepared multimedia materials. We used repeated
measured ANOVA and Mann–Whitney U test to compare the distribution of Mini-CEX scores across
corresponding groups. Analysis was done using the SPSS software version 23 (IBM SPSS Statistics
for Windows. Armonk, NY, USA: IBM Corp).
RESULTS: The median Mini-CEX score (IQR) of students in preintervention and postintervention
groups were 16.14 (5.19) and 19.62 (3.13), respectively. Findings of this study showed a significant
increase in mini-CEX scores of the groups who used the multimedia learning material compared to
those who did not use it (P < 0.001).
CONCLUSIONS: Multimedia learning resources demonstrated a promising influence on internal
residents’ mini‑CEX scores in this study. They demonstrate significantly greater performance after
using multimedia learning materials compared to their same‑year residents who did not benefit from
it. This demonstrates the favorable effect of multimedia on the acquisition of practical skills such as
obtaining a history or performing a physical examination.

Abstract BACKGROUND: Kane’s validity framework examines the validity of the interpretation of a test at the
four levels of scoring, generalization, extrapolation, and implications. No model has been yet proposed
to use this framework particularly for a system of assessment. This study provided a model for the
validation of the internal medicine residents’ assessment system, based on the Kane’s framework.
MATERIALS AND METHODS: Through a five stages study, first, by reviewing the literature, the
methods used, and the study challenges, in using Kane’s framework, were extracted. Then, possible
assumptions about the design and implementation of residents’ tests and the proposed methods for
their validation at each of their four inferences of Kane’s validity were made in the form of two tables.
Subsequently, in a focus group session, the assumptions and proposed validation methods were
reviewed. In the fourth stage, the opinions of seven internal medicine professors were asked about
the results of the focus group. Finally, the assumptions and the final validation model were prepared.
RESULTS: The proposed tables were modified in the focus group. The validation table was developed
consisting of tests, used at each Miller’s pyramid level. The results were approved by five professors
of the internal medicine. The final table has five rows, respectively, as the levels of Knows and Knows
How, Shows How, Shows, Does, and the fifth one for the final scores of residents. The columns
of the table demonstrate the necessary measures for validation at the four levels of inferences of
Kane’s framework.
CONCLUSION: The proposed model ensures the validity of the internal medicine specialty residency
assessment system based on Kane’s framework, especially at the implication level.

Abstract BACKGROUND: Respiratory diseases are a major cause of mortality and morbidity worldwide.
A sound knowledge of management of respiratory diseases is thus very vital. The clinical exposure
of undergraduate medical students is limited to 2 weeks in pulmonary medicine. We hypothesized
that the short duration of posting can be best utilized by developing need‑based modules for bedside
teaching.
AIMS: This study aimed to determine gain in knowledge and skills of final‑year medical students
in diagnosis and management of common pulmonary diseases and assess students’ perception of
the module.
METHODS: A one‑group pretest‑posttest quasi‑experimental study design enrolled a convenience
sample of 48 final‑year medical students. Twenty‑four students were posted at a given time for the
bedside clinical posting in pulmonary medicine between August 2013 and November 2013. These
students were divided randomly into two groups of 12 students each. All students consented to be
part of the study. Two trained faculty taught in rotation. The bedside teaching module was prepared
by Delphi technique and curriculum was based on Kern’s six‑step approach. History taking, physical
examination, tuberculosis, chronic obstructive pulmonary disease, asthma, lung cancer, chest X‑rays,
and spirometry were taught. Students were administered pre‑ and post‑test questionnaires to assess
knowledge, while Objective Structured Clinical Examination assessed skills. Students’ feedback
questionnaire evaluated the teaching module. A two‑tailed paired sample t‑test assessed mean gain
in knowledge and skills. Effect size was calculated by Cohen’s d, while Cronbach’s alpha estimated
the reliability testing of perception questionnaire. Statistical analysis was performed using statistical
software package IBM SPSS version 23.
RESULTS: Mean pre‑ and posttest knowledge scores were 12.46 (8.09) and 43.17 (10.7),
respectively, P = 0.001. Mean pre‑ and posttest skills scores were 7.00 (4.76) and 24.79 (3.31),
respectively, P = 0.001, and Cohen’s d showed large effect size. Most students stated that the
module enhanced their clinical skills, helped to understand difficult material, and promoted inquiry
and thinking. Cronbach’s alpha for perception questionnaire was 0.854.
CONCLUSIONS: Structured bedside teaching module in pulmonary medicine improved the knowledge
and skills of undergraduate medical students. The contents and various teaching methodologies
were evaluated positively.