Pharmacy education

药学教育
  • 文章类型: Journal Article
    药学专业的学生积极将人工智能和ChatGPT融入他们的实践中。这项研究的目的是调查药学学生使用ChatGPT的直接短期学习效果。
    这是一项随机实验研究。将学生分为两组;干预组(n=15)使用所有研究工具和ChatGPT,而对照组(n=16)使用所有研究工具,除了ChatGPT.组间的差异是通过他们在短期研究前后的知识测试中表现如何来衡量的。
    在预测试评分中,干预组和对照组之间的能力水平没有显着差异(p=0.28)。使用ChatGPT也没有显著效果,在12点量表上平均调整后的差异为0.5点。然而,与对照组(16个中的1个)相比,ChatGPT参与者的分数(15个中的4个)增加较大(至少4个)的比例有趋势。
    ChatGPT对药学专业学生的学习结果有潜在的积极影响,然而,目前的研究不足以衡量ChatGPT对短期学习的统计学显著影响.
    UNASSIGNED: Students in pharmacy are positive towards integrating artificial intelligence and ChatGPT into their practice. The aim of this study was to investigate the direct short-term learning effect of using Chat GPT by pharmacy students.
    UNASSIGNED: This was an experimental randomized study. Students were allocated into two groups; the intervention group (n = 15) used all study tools and ChatGPT, while the control group (n = 16) used all study tools, except ChatGPT. Differences between groups was measured by how well they performed on a knowledge test before and after a short study period.
    UNASSIGNED: No significant difference was found between the intervention and control groups in level of competence in the pretest score (p = 0.28). There was also no significant effect of using ChatGPT, with a mean adjusted difference of 0.5 points on a 12-point scale. However there was a trend towards a higher proportion of ChatGPT participants having a large (at least four point) increase in score (4 out of 15) vs control group (1 out of 16).
    UNASSIGNED: There is a potential for positive effects of ChatGPT on learning outcomes in pharmacy students, however the current study was underpowered to measure a statistically significant effect of ChatGPT on short term learning.
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  • 文章类型: Case Reports
    背景:学生完成的课程评估通常包含在大学教师晋升和任期数据包中,但可能不是学生学习的最佳指标。这种并置创造了一个挑战-公制教师首先要改进的是学生的学习而不是学生的感知,但是课程改变改善学生学习并不总是导致更高的课程评估分数。此外,更改课程对教师来说可能是耗时的。该项目的目的是评估对课程的更改,做出这些改变所花费的时间,以及这些变化对课程评价分数和学生成绩的影响。
    在2023年秋季修订了主要课程项目,重点是管理和商业计划;修订的目标是在尽可能少的教师时间内解决课程评估分数差和学生对课程的负面看法,同时保持学生工作质量。主要变化围绕业务计划项目和课程沟通的转变。通过对2023年队列的期中调查和讨论以及期末调查来评估变化,并比较2022年和2023年队列之间的课程评估和学生工作产品。
    对于修订后的2023年秋季课程,课程评估分数得到了提高,学生的反馈更加积极。实施的更改不会对学生的表现产生负面影响,因为两个学期都保持了商业计划项目的质量。通过期中调查和讨论,教师的透明度和响应能力可能会对课程评估分数产生积极影响。总的来说,课程更改不需要花费大量的教师时间,但是提高课程评估分数的预期结果得到了认可。
    BACKGROUND: Student-completed course evaluations are often included in university faculty promotion and tenure packets but may not be the best metrics for student learning. This juxtaposition creates a challenge - the metric faculty first want to improve is student learning rather than student perception, but course changes improving student learning do not always result in higher course evaluation scores. Additionally, making course changes can be time consuming for faculty. The objective of this project was to assess the changes made to a course, the time spent making those changes, and the impact of the changes on course evaluation scores and student performance.
    UNASSIGNED: A single course focused on management with a business plan as the primary course project was revised in Fall 2023; the goal of revisions was to address poor course evaluation scores and negative student perceptions of the course in as little faculty time as possible while maintaining quality of student work. Primary changes centered around the business plan project and a shift in course communication. Evaluation of the changes occurred through mid-semester survey and discussion and end-of-semester survey for the 2023 cohort, and comparing course evaluations and student work products between the 2022 and 2023 cohorts.
    UNASSIGNED: Course evaluation scores were improved and student feedback was more positive for the revised Fall 2023 course. The implemented changes did not negatively affect student performance as quality of the business plan project was maintained across both semesters. Instructor transparency and responsiveness through the mid-semester survey and discussion may have positively influenced course evaluations scores. Overall, the course changes did not take a significant amount of faculty time, but the desired outcome of improving course evaluation scores was recognized.
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  • 文章类型: Journal Article
    所有药剂师都应准确进行药物计算,以确保患者安全。近年来,在北美药剂师执照考试中,与计算相关的绩效呈下降趋势。了解这种下降的原因并确定纠正潜在问题的方法可能会使药房管理部门受益。教员,学生,和病人。本评论的目的是介绍影响学生药学计算能力的因素,讨论数学技能下降的后果,并呼吁采取行动,为与计算有关的教学和学习提供奖学金,并增加行政支持以纠正这一挑战。
    All pharmacists are expected to accurately perform pharmaceutical calculations to ensure patient safety. In recent years, there have been trends in declining performance on the North American Pharmacist Licensure Examination related to calculations. Understanding the cause of this decline and determining methods to correct underlying issues could benefit pharmacy administration, faculty, students, and patients. The aims of this commentary are to present the factors impacting the students\' pharmaceutical calculations abilities, discuss the consequences of declining math skills, and provide a call to action for scholarship of teaching and learning pertaining to calculations, as well as increased administrative support to rectify this challenge.
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  • 文章类型: Journal Article
    未来几年医院药剂师的培训必须适应和应对当前和未来的社会和技术挑战,不忽视专业的基本领域。有必要获得所谓的数字综合健康知识:人工智能,技术和自动化,数字技能,以及与患者沟通的新形式,例如远程医疗和远程药房,这在许多医院已经成为现实。我们必须提供有关药品分配和分配的自动化系统的知识,用于准备无菌制剂的机器人,可追溯性系统,无人机在临床护理中的使用,等。以及技术在药学服务中的应用培训,通过设备和应用程序,帮助早期有效地识别需要特定护理的患者。在这个数字场景中,必须面对新的风险和挑战,例如网络安全和网络弹性,这使得医疗保健专业人员的培训和教育,尤其是医院药剂师,不可原谅.另一方面,日益复杂和创新的疗法的出现不仅对健康人群而且对经济和环境问题都有很大影响,这使得新的能力和技能对于开发和实施破坏性和有能力的融资至关重要,股本,和可持续性战略。在这个要求苛刻且高度互联的环境中,可以理解的是,众所周知的“筋疲力尽的工人综合症”出现了,这阻碍了团队的正确个人和专业发展,并强调了质量培训对其预防和管理的重要性。总之,在接下来的十年里,医院药剂师的培训必须旨在提供创新和基本技能方面的知识,以适应和成功适应当前的需求和变化。
    The training of hospital pharmacists in the coming years must adapt and respond to constant current and future social and technological challenges, without neglecting the basic areas of the profession. It is necessary to acquire knowledge in what is known as digital comprehensive health: artificial intelligence, technology and automation, digital skills, and new forms of communication with patients, such as telemedicine and telepharmacy that are already a reality in many hospitals. We must provide knowledge in automated systems for the distribution and dispensing of medicines, robots for preparing sterile preparations, traceability systems, the use of drones in clinical care, etc. as well as training in the application of technology in pharmaceutical care, through devices and applications that help identify patients who require specific care early and effectively. In this digital scenario, new risks and challenges must be faced, such as cybersecurity and cyber resilience, which makes the training and education of healthcare professionals in general, and hospital pharmacists in particular, inexcusable. On the other hand, the appearance of increasingly complex and innovative therapies has a great impact not only on health population but also on economic and environmental issues, which makes new competencies and skills essential to develop and implement disruptive and competent financing, equity, and sustainability strategies. In this demanding and hyper-connected environment, it is understandable that the well-known \"burned out worker syndrome\" appears, which prevents the correct personal and professional development of the team and highlights the importance of quality training for its prevention and management. In short, in the next decade, the training of hospital pharmacists must be aimed at providing knowledge in innovation and in basic skills needed to adapt and succeed to current demands and changes.
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  • 文章类型: Journal Article
    未来几年医院药剂师的培训必须适应和应对当前和未来的社会和技术挑战,不忽视专业的基本领域。有必要获得所谓的数字综合健康知识:人工智能,技术和自动化,数字技能,以及与患者沟通的新形式,例如远程医疗和远程药房,这在许多医院已经成为现实。我们必须提供有关药品分配和分配的自动化系统的知识,用于准备无菌制剂的机器人,可追溯性系统,无人机在临床护理中的使用,等。,以及包括在药学服务中应用技术的培训,通过设备和应用程序,帮助早期有效地识别需要特定护理的患者。在这个数字场景中,必须面对新的风险和挑战,例如网络安全和网络弹性,这使得医疗保健专业人员的培训和教育,尤其是医院药剂师,必要的。另一方面,日益复杂和创新的疗法的出现不仅对健康人群而且对经济和环境问题都有很大影响,这使得新的能力和技能对于开发和实施破坏性和有能力的融资至关重要,股本,和可持续性战略。在这个要求苛刻且高度互联的环境中,可以理解的是,众所周知的“筋疲力尽的工人综合症”出现了,这阻碍了团队的正确个人和专业发展,并强调了质量培训对其预防和管理的重要性。总之,在接下来的十年里,医院药剂师的培训必须旨在提供创新和基本技能方面的知识,以适应和成功适应当前的需求和变化。
    The training of hospital pharmacists in the coming years must adapt and respond to constant current and future social and technological challenges, without neglecting the basic areas of the profession. It is necessary to acquire knowledge in what is known as digital comprehensive health: Artificial intelligence, technology and automation, digital skills, and new forms of communication with patients, such as telemedicine and telepharmacy that are already a reality in many hospitals. We must provide knowledge in automated systems for the distribution and dispensing of medicines, robots for preparing sterile preparations, traceability systems, the use of drones in clinical care, etc., as well as including training in the application of technology in pharmaceutical care, through devices and applications that help identify patients who require specific care early and effectively. In this digital scenario, new risks and challenges must be faced, such as cybersecurity and cyber-resilience, which makes the training and education of healthcare professionals in general, and hospital pharmacists in particular, essential. On the other hand, the appearance of increasingly complex and innovative therapies has a great impact not only on health population but also on economic and environmental issues, which makes new competencies and skills essential to develop and implement disruptive and competent financing, equity, and sustainability strategies. In this demanding and hyper-connected environment, it is understandable that the well-known \"burned out worker syndrome\" appears, which prevents the correct personal and professional development of the team and highlights the importance of quality training for its prevention and management. In short, in the next decade, the training of hospital pharmacists must be aimed at providing knowledge in innovation and in basic skills needed to adapt and succeed to current demands and changes.
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  • 文章类型: Journal Article
    背景:虽然药房项目,标准,随着时间的推移,学生们也发生了变化,照顾我们的学生仍然是最重要的。我们有兴趣了解学院和药学院如何满足这些需求。因此,我们的目标是描述与药学学院/学校相关的学生事务专业人员的角色和责任。
    方法:通过电子邮件与美国所有ACPE学院/药学院联系,以确定该机构的学生事务负责人,然后通过电子邮件向其发送Qualtrics调查。调查要求提供大学/学校的人口统计信息以及学生事务教职员工的人数和职责的详细信息。使用描述性统计来总结结果。
    结果:调查共发送给134个人,在删除重复的答复后,收到了78份调查答复。回应大学/学校的类型相似(49%是公共的,51%私人),大小(59%进入<80名学生的队列,而全国为55%),与所有认可的学院/药学院相比,课程长度(65%的课程至少4年)。最多的计划有一到三个全职等效(FTE)职位(39%),三到五个FTE紧随其后(31%)。最频繁发生的团队组成(N=20)是零到一名FTE院长/副院长/助理院长和至少两名非教职员工。组织学生定向,策划活动,如头巾和白大褂仪式,监督学生组织,监督学生福利计划和学生招募最常被报告为学生事务办公室的责任。
    结论:总体而言,我们的调查结果表明,最常见的学生事务办公室由一名院长/副院长/助理院长和至少两名非教师专业人员组成。我们调查的局限性在于未要求受访者在调查中完成大学/学校领域。
    结论:在相应的学院/学校中,专门用于学生事务,头衔和职责的FTE职位的数量和类型差异很大。
    BACKGROUND: While pharmacy programs, standards, and students have changed over time, caring for our students continues to be of the utmost importance. We are interested in learning how colleges and schools of pharmacy are meeting these needs. Therefore, our objective was to characterize the roles and responsibilities of student affairs professionals associated with colleges/schools of pharmacy.
    METHODS: All ACPE colleges/schools of pharmacy in the United States were contacted by email to identify the student affairs lead for the institution who was then sent a Qualtrics survey via email. The survey asked for college/school demographics and details of the number and responsibilities of student affairs faculty and staff. Descriptive statistics were used to summarize the results.
    RESULTS: The survey was sent to a total of 134 individuals and 78 survey responses were received after removing duplicate responses. Responding college/schools were similar in type (49% public, 51% private), size (59% entering cohort of <80 students compared to 55% nationally), and length of program (65% with program at least 4 years) compared to all accredited colleges/schools of pharmacy. The greatest number of programs had between one and three full-time equivalent (FTE) positions (39%) with between three and five FTEs close behind (31%). The team make up that occurred most frequently (N = 20) was zero to one FTE Dean/Associate/Assistant Dean and at least two non-faculty professional staff. Organizing student orientation, planning events such as hooding and white coat ceremonies, overseeing student organizations, and overseeing student wellbeing programs and student recruitment were most frequently reported to be responsibilities of student affairs offices.
    CONCLUSIONS: Overall, our findings show that the most common student affairs offices are comprised of one Dean/Associate Dean/Assistant Dean and at least two non-faculty professional staff. A limitation of our investigation was the omission of a requirement for respondents to complete the college/school field in the survey.
    CONCLUSIONS: The number and types of FTE positions devoted to student affairs and titles and responsibilities differed greatly among the responding colleges/schools.
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  • 文章类型: Journal Article
    背景:尼日利亚是位于撒哈拉以南非洲的中低收入国家。尽管癌症负担随着时间的推移而持续增加,缺乏专门从事肿瘤学的药剂师提供药学服务。这项研究的目的是了解尼日利亚对血液学/肿瘤学药学实践的看法以及未满足的教育需求。
    方法:这是一项于2023年12月进行的横断面调查。邀请尼日利亚各种药房组织的活跃成员药剂师完成调查。调查的重点是对肿瘤药房培训需求的看法,当前的挑战和机遇,以及所需的资源和支持。描述性统计用于数据分析。
    结果:在263名响应者中,最大的群体在25至34岁之间(35%),超过一半的人获得了药学学士学位作为他们的最高学位(53%),大多数人没有接受任何肿瘤学药学培训作为其教育的一部分(73%).许多受访者强烈同意尼日利亚的药剂师需要接受专门培训,以更好地为癌症患者服务(79%)。与其他培训需求相比,癌症治疗和化疗药理学更优先(平均值(SD):2.63(1.95)和2.69(1.64),分别)。受访者面临的主要挑战是缺乏肿瘤药学相关技能和知识(平均值(SD):2.23(1.53))。超过四分之一的受访者了解董事会认证流程(28.8%),将克服成本障碍作为参加董事会考试的主要障碍(平均值(SD):1.92(1.38))。受访者更喜欢在线课程和现场专业培训(75%)作为满足未满足需求的培训模式。
    结论:尽管在血液学/肿瘤学临床实践中存在挑战和未满足的教育需求,尼日利亚药剂师非常愿意扩大他们的知识并提高他们在患者护理方面的技能。这项研究的结果可以为政策制定者提供信息,医疗保健管理员,和药房教育工作者在药房组织之间发展全球伙伴关系,这些组织采用有针对性的战略,如赞助,以解决这些未满足的需求。
    BACKGROUND: Nigeria is a low-middle income country located in sub-Saharan Africa. Although cancer burden has continued to increase over time, there is a lack of pharmacists who specialize in oncology providing pharmaceutical care. The objectives of this study were to understand the perception of hematology/oncology pharmacy practice in Nigeria as well as the unmet education needs.
    METHODS: This is a cross-sectional survey conducted in December 2023. Pharmacists who were active members of various pharmacy organizations in Nigeria were invited to complete the survey. The survey focused on the perceptions of training needs in oncology pharmacy, current challenges and opportunities, as well as resources and support needed. Descriptive statistics were utilized for the data analysis.
    RESULTS: Of the 263 responders, the largest group fell between 25 and 34 years old (35%), over half received a Bachelor of Pharmacy as their highest degree (53%), and majority did not receive any oncology pharmacy training as part of their education (73%). Many respondents strongly agreed that pharmacists in Nigeria need specialized training to better serve cancer patients (79%). Cancer therapeutics and chemotherapy pharmacology were more prioritized compared to other training needs (mean (SD): 2.63(1.95) and 2.69(1.64), respectively). The main challenge that respondents faced was a lack of relevant skills and knowledge in oncology pharmacy (mean (SD): 2.23(1.53)). More than a fourth of the respondents were aware about the board certification process (28.8%), citing overcoming the cost barrier as the main obstacle for taking the board examination (mean (SD): 1.92 (1.38)). Respondents preferred online courses and onsite specialty training (75%) as the mode of training to address unmet needs.
    CONCLUSIONS: Despite the challenges and unmet education needs in hematology/oncology clinical practice, Nigerian pharmacists are very willing to expand their knowledge and improve their skills in patient care. The findings of this study can inform policy makers, healthcare administrators, and pharmacy educators in developing global partnerships among pharmacy organizations which employ targeted strategies like sponsorships to address such unmet needs.
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  • 文章类型: Journal Article
    目的:目的是使用8步Kotter变更模型来描述课程修订过程的影响,以减少公众PharmD计划中的课程过载,研究型药学院。
    方法:与8步Kotter变更模型一致,第一步是创造变革的紧迫性,这得到了采取行动解决课程过载的呼吁的支持。接下来,一个变革领袖联盟成立了,他制定了七个课程更新目标,以共同解决课程过载问题。在整个变革过程中,这一愿景在教师会议上得到了传达,请求反馈。成立了五个课程工作组,以根据他们的指控授权采取行动。早期采用者创造了快速的胜利,这建立了势头,并导致了更简化的路线变更过程。最后,做出改变需要持续的评估。
    结果:总计,所需的教学学分从92.6减少到79,教学课程从31减少到23,同时确保所有所需内容仍然存在。对于许多课程,联络时间也减少,以符合分配的学分。一路上遇到了障碍和挑战,以及寻找解决方案的协作方法被证明是有益的。
    结论:实施课程变更以解决过载的主要建议包括建立变更模型,并确定变革领导者以支持变革并有效解决教职员工的问题。通过重复消息传递进行有效沟通至关重要。虽然变化是复杂的,以耐心和毅力投入它可以导致成功。
    OBJECTIVE: The objective is to describe the impact of a curricular revision process using the 8-step Kotter change model to decrease curricular overload in a Doctor of Pharmacy program at a public, research-intensive school of pharmacy.
    METHODS: In alignment with the 8-step Kotter change model, the first step was to create urgency for change, which was supported by calls to action to address curricular overload. Next, a coalition of change leaders was formed, who developed 7 curriculum renewal targets to collectively address curricular overload. This vision was communicated at faculty meetings throughout the change process, with requests for feedback. Five curricular working groups were formed to empower action based on their charges. Quick wins were created by early adopters, which built momentum and led to a more streamlined course change process. Lastly, making changes stick requires ongoing evaluation.
    RESULTS: In total, required didactic credits were reduced from 92.6 to 79 and didactic courses were reduced from 31 to 23 while ensuring that all required content remained. For many courses, contact hours were also reduced to align with allotted credit hours. Obstacles and challenges were encountered along the way, and a collaborative approach to finding solutions proved beneficial.
    CONCLUSIONS: The key recommendations for implementing curricular changes to address overload include having a change model in place and identifying change leaders to support change and address faculty concerns efficiently. Effective communication through repetition of messaging is critical. Although change is complex, leaning into it with patience and perseverance can lead to success.
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  • 文章类型: Journal Article
    背景:药剂师需要更深入地了解患者对医学的看法,以针对他们的咨询和改善患者的预后。病人模拟练习,在那里,药学学生被要求消费类似药物的产品,已经被证明可以促进这种理解,尽管这是如何发生的细节,尤其是,学生们如何将他们的第一人称视角转向对真正患者的药物生活的概括,没有很好的记录。目的是通过引入有关真实患者的反思问题来确定学习过程的中心方面,并在研究期间跟踪学生的发展。
    方法:这项研究是在第4个学期的学生中进行的,他们在一个调查工具中被要求回答关于他们每天服用甘草产品一周的经历的自由文本问题,并回答患者的反思问题。定性演绎分析是通过根据“体验式学习”的概念对学生的经验进行编码来进行的。然后推断每个概念内的模式识别,他们的相互关系也是如此。
    结果:患者反思问题使学生能够将第一人称观点转向有关真实患者的药物生活的相关概括,包括涉及的心理机制以及实际患者群体在定期服药能力上的差异。学生在一周内面临挑战,遵循所需的剂量方案来更细致入微地认识到,药物依从性需要特别的努力,并限制了一个人的日常生活;因此,负面情绪参与了学习过程。
    结论:简单的患者模拟练习的设计引起了对患者使用药物的真实生活的新型见解。由于消极情绪干扰了学生的锻炼要求和正常的社交生活,以及对这项工作的承诺,是这个过程的重要方面。
    BACKGROUND: Pharmacists need more insight into patients\' perspectives on medicine to target their counseling and improve patient outcomes. Patient simulation exercises, where pharmacy students are asked to consume medicine-like products, have been shown to foster such understandings, although the specifics of how this occurs, in particularly, how students turn their first-person perspectives toward generalizations about real patients\' lives with medicines, are not well documented. The aim was to identify central aspects of the learning process by introducing reflection questions about real patients and follow students\' development during a study period.
    METHODS: The study was conducted with students in their 4th semester in the second year of Pharmacy Education at the University of Copenhagen who were asked to respond to free text questions in a survey instrument about their daily experiences of taking a licorice product for one week as well as answering patient reflection questions. Qualitative deductive analysis was performed by coding students\' experiences according to concepts of \'experiential learning\'. Pattern identification within each concept was then inferred, as were their interrelationships.
    RESULTS: Patient reflection questions enabled students to turn their first-person perspectives toward relevant generalizations about real patients\' lives with medicines, including involved psychological mechanisms and how real patient groups differ in their ability to take medicine regularly. Students who during the week faced challenges with following the required dosing scheme came to more nuanced realizations that medicine adherence requires special efforts and restricts one\'s daily life; hence, negative emotions were involved in the learning process.
    CONCLUSIONS: The design of the simple patient simulation exercise gave rise to new types of insights into real patients\' lives with medicines. Negative emotions due to interference between the requirements of the exercise and students\' normal social lives, as well as commitment to the exercise, were important aspects of this process.
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  • 文章类型: Journal Article
    目的:确定在一个机构的两个学期中,一个课程系列中的项目编写缺陷和认知水平对学生表现指标的影响。
    方法:四位研究者回顾了综合治疗课程系列的928项多项选择项目。检查了有缺陷的项目和标准项目之间的绩效指标差异,有缺陷的茎和有缺陷的答案选择,和认知水平。
    结果:审核员发现80%的项目有缺陷,最常见的类型是令人难以置信的干扰物和不集中的茎。有缺陷的物品比标准的容易,项目变得更容易,因为他们积累了更多的缺陷。这些缺陷使表现较低的学生比表现较高的学生受益更多,特别是两个缺点。茎有缺陷的项目与标准项目具有相同的难度,但是那些有错误答案的人要容易得多。大多数项目测试较低级别的技能,并且比高级别的项目有更多的缺陷。低级和高级认知项目之间的难度没有显着差异,较高级别的项目比茎缺陷更有可能具有答案缺陷。
    结论:项目写作缺陷对学生表现的影响不同。令人难以置信的干扰因素人为地降低了问题的难度,即使是那些旨在评估高级技能的人。这种影响导致较高和较低级别项目之间的难度缺乏显着差异。不集中的茎,另一方面,无论问题的认知复杂性如何,都可能增加混乱并阻碍表现。
    OBJECTIVE: To determine the impact of item-writing flaws and cognitive level on student performance metrics in 1 course series across 2 semesters at a single institution.
    METHODS: Four investigators reviewed 928 multiple-choice items from an integrated therapeutics course series. Differences in performance metrics were examined between flawed and standard items, flawed stems and flawed answer choices, and cognitive levels.
    RESULTS: Reviewers found that 80% of the items were flawed, with the most common types being implausible distractors and unfocused stems. Flawed items were generally easier than standard ones, but the type of flaw significantly impacted the difficulty. Items with flawed stems had the same difficulty as standard items; however, those with flawed answer choices were significantly easier. Most items tested lower-level skills and have more flaws than higher-level items. There was no significant difference in difficulty between lower- and higher-level cognitive items, and higher-level items were more likely to have answer flaws than item flaws.
    CONCLUSIONS: Item-writing flaws differently impact student performance. Implausible distractors artificially lower the difficulty of questions, even those designed to assess higher-level skills. This effect contributes to a lack of significant difference in difficulty between higher- and lower-level items. Unfocused stems, on the other hand, likely increase confusion and hinder performance, regardless of the question\'s cognitive complexity.
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