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Comments on strategic issues of public health education and workforce training in China Du Jian, Zhan Qimin 2020, 40 (8):  577-581.  DOI: 10.3760/cma.j.cn115259-20200416-00581 Abstract ( 86 )   PDF (827KB) ( 92 )   Under the ongoing COVID-19 epidemic, an in-depth thinking was given on several strategic issues of public health education and workforce training in China, from the perspective of social system, instead of just health and medical centric. Public health education needs to extend from human health-centric to healthy people, healthy animals, and a healthy environment, i.e., One Health. In addition, more attention should be paid to the role of innovative biomedical technology and digital technology in public health protection. Under the concepts of Public Health 3.0, One Health, and health security, it is suggested to attach great importance to the public health education and workforce training from the strategic level of national security and health for all. A large public health clinical training system that combines college, post-graduate, and continuing education systems should be built. At the post-graduation stage, a public health physician training system needs to be established and incorporated into the standardized training system for resident doctors. Education reforms may start with the establishment of an accreditation system, redesign of curriculum, and an examination of the core competencies in public health. The institutional exchanges between the medical system and the CDC system should be improved. It is also important to strengthen the regular training for local health administrative leaders on the ability of both diseases control and emergency preparations. References | Related Articles | Metrics

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Investigation and analysis of mental health relevant factors of medical graduates of various grades in a university Ge Wenjia, Wei Jing, Xu Wanfei, Ren Ruimin 2020, 40 (8):  582-585.  DOI: 10.3760/cma.j.cn115259-20191230-01130 Abstract ( 64 )   PDF (782KB) ( 45 )   Objective Through investigating the mental health status of medical graduate students of all grades(hereinafter referred to as medical graduate students), and focusing on analyzing the psychological health of the third grade graduate students,we provide theoretical basis for the psychological health counseling of medical graduates who are about to graduate.Methods Using resilience scale, stressor scale and symptom Checklist-90 (SCL-90), 941 medical postgraduates from grade 2016 to grade 2018 in three tertiary hospitals affiliated to a university were investigated and analyzed.Results The mental health level of medical graduates was generally good(64.81±9.99 vs 59.97±10.46). The mental health of the third grade medical graduates was worse than that of the first and second grade medical postgraduates(61.91±7.83 vs 67.51±11.79,67.26±9.40).The most prominent mental stress of the third grade students was employment(2.60±0.67) and study(2.51±0.70).The mental status of the third grade medical graduates who were male,single or in love was higher than that of the third grade medical graduates who were female or married (65.04±9.27 vs 60.16±10.46,P=0.008; 61.52±4.93, 64.20±7.19 vs 57.82±6.97, P=0.010). The positive rate of the third grade students was 21.9%(65/297), and the positive rate of urban students was higher than that of rural students,the difference was statistically significant(23.8% vs 18.3%, P<0.01).Conclusions The mental health problems of graduating medical graduates cannot be ignored.Urban students and married students have relatively poor psychological status. The relevant departments should take targeted measures to conduct psychological counseling and preventive intervention based on influencing factors. References | Related Articles | Metrics

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The current status and influencing factors of anxiety and depression in professional master degree of clinical medicine in a medical college Dong Yali, Zhao Ting, Gu Xiaofen 2020, 40 (8):  586-589.  DOI: 10.3760/cma.j.cn115259-20190819-00667 Abstract ( 48 )   PDF (777KB) ( 45 )   Objective To understand the anxiety and depression levels ofprofessional master degree(PMD) of clinical medicine in clinical medicine in a medical college, and to find the influencing factors.Methods 1 286 PMD were surveyed by SAS and SDS, which were compiled by Zung from June to August 2019.Results The SAS score of PMD was higher than that of national norm (45.91±11.36) vs(29.78±6.46),P<0.01; and the SDS score of PMD was higher than that of national norm (49.84±13.07) vs(33.46±8.55), P<0.01. Female PMD are 1.775 times more likely to suffer from anxiety and depression than male PMD (OR=1.775, 95%CI:1.250 ~ 2.520). The risk of anxiety and depression was 1.525 times (OR=1.525, 95%CI:1.007 ~ 2.329) for PMD with research pressure from supervisors. The risk of anxiety and depression was 1.614 times that of the sleep-deprived PMD (OR=1.614, 95%CI: 1.109~2.350).Conclusions The level of anxiety and depression of PMD is higher than that in national norm. Supervisor research pressure and insufficient sleep are the risk factors of anxiety and depression of for PMD. To improve the mental health of PMD, it should be paid attention to and intervene the anxiety and depression. References | Related Articles | Metrics

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Study on psychological stress and coping style of medical undergraduates in ophthalmic clinical practice Wei Yumin, Zhong Zhiyong, Zou Yuxian, Gao Ya 2020, 40 (8):  590-593.  DOI: 10.3760/cma.j.cn115259-20190811-00654 Abstract ( 49 )   PDF (778KB) ( 38 )   Objective To study the correlation between psychological stress and coping style of medical undergraduates participating in ophthalmic clinical practice, and to provide scientific basis for promoting the development of mental health of medical students.Methods All 105 medical undergraduates from Sun Yat-sen University who participated in the clinical practice of ophthalmology were investigated by means of general situation questionnaire, psychological stress questionnaire and simple coping style questionnaire.Results According to the description of median and quartile distance, the total stress of Undergraduates in ophthalmology clinical practice is 3.0(3.0,4.0),and the total score of psychological stress is 105.0(98.0,110.0).The difference of psychological pressure of students with different demographic characteristics is statistically significant. The scores of positive and negative coping were 1.67(1.63,1.78)and 1.28(1.26,1.36), respectively. In terms of positive coping style, the scores of female, urban and non first practice students are higher than that of male, rural and first practice students respectively[1.69(1.65,1.78)vs 1.63(1.61,1.84),1.69(1.65,1.85)vs 1.63(1.59,1.63),1.78(1.69,1.86)vs 1.63(1.60,1.64)]; in terms of negative coping style, the scores of first practice are higher than that of non first practice students [1.28(1.25,1.32)vs 1.27(1.26,1.36)]. All kinds of psychological stress were negatively correlated with the score of positive coping (all P<0.05), while social,life,self-development,job selection stress and total stress were positively correlated with the score of negative coping (all P<0.05).Conclusions Medical undergraduates bear psychological pressure in ophthalmic clinical practice, and are influenced by gender, household registration, practical experience and other factors. At the same time, the coping style of students facing pressure is relatively single. Educators should pay close attention to the psychological stress and coping style of medical undergraduates who take part in the clinical practice of ophthalmology, carry out mental health education and guidance according to the characteristics of different groups, take effective measures to reduce the psychological stress of students and promote mental health. References | Related Articles | Metrics

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Application of flipped classroom based on small private online course in the training of advanced cardiovascular life support Zheng Ziyu, Ye Jialin, Liao Jinli 2020, 40 (8):  594-597.  DOI: 10.3760/cma.j.cn115259-20191125-01019 Abstract ( 65 )   PDF (777KB) ( 58 )   Objective To explore the application effect of flipped classroom teaching method based on small private online course (SPOC) in the teaching of advanced cardiovascular life support in emergency department.Methods In September 2019, Ninety-eight undergraduates of eight-year program of clinical medicine enrolled in 2014 from Sun Yat-sen University were randomly divided into experimental group and control group with 49 in each. The experimental group adopts the flipped classroom teaching method based on SPOC, while the control group adopts the traditional teaching method. Through the theoretical test results of two groups of students, the scores and questionnaire results of the simulation exercise of advanced cardiovascular life support cases, the teaching effect was evaluated.Results The theoretical knowledge test scores of the experimental group were significantly higher than that of the control group [(83.18±1.71) vs (77.47±1.49)], P<0.01. No significant difference was found in individual performance [(67.55±1.67) vs (63.88±2.30)] and team performance [(67.76±1.12) vs (66.63±2.13)](all P>0.05).In terms of increasing learning initiative and enthusiasm, the satisfaction of students between the experimental group and the control group to their respective teaching methods was compared [81.6% (40/49) vs 16.3% (8/49)], the difference was statistically significant (P<0.05).Conclusions The flipped classroom teaching method based on SPOC improve the test results of theoretical knowledge of advanced cardiovascular life support, and get high evaluation from students, but it has no obvious impact on the examination results of students' case simulation exercise. How to use this teaching method to guide students to apply theoretical knowledge to practice still needs further research. References | Related Articles | Metrics

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The application of multi-disciplinary team teaching mode in ultrasonography practice teaching Han Xue, Lan Tian, Zheng Jian, Li Bo, Sun Yixin, Liu Zhao, Cheng Wen 2020, 40 (8):  598-601.  DOI: 10.3760/cma.j.cn115259-20200119-00078 Abstract ( 57 )   PDF (804KB) ( 50 )   The advantage of ultrasonography is noninvasive, no radiation, flexible operation and so on. It has been carried out in all levels of hospitals.However, the number of clinical doctors who can do ultrasound examination is limited.How to cultivate students who can carry out clinical work independently after graduation in a limited time is an important problem for medical educators.The guiding opinions on accelerating the construction of “double first-class” in institutions of higher learning point out that the cross-discipline promotes the development of disciplines.Multi-disciplinary team diagnosis and treatment model has been widely used in clinical work and achieved good results.According to the guiding ideology of the ministry of education and clinical practice, this paper makes an in-depth discussion on how to apply the multi-disciplinary team mode to the practical teaching of ultrasound. It can improve the current teaching mode and the teaching quality, and cultivate high-quality ultrasonic medical talents for the society. References | Related Articles | Metrics

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Application of wisdom teaching tool Rain Classroom in pathophysiology teaching Zeng Zhen, Lin Min 2020, 40 (8):  602-605.  DOI: 10.3760/cma.j.cn115259-20200106-00021 Abstract ( 49 )   PDF (813KB) ( 47 )   Objectives To evaluate the wisdom teaching tool Rain Classroom in the learning of pathophysiology.Methods Questionnaire survey was used in this study. In 2018, 96 students majoring in five-year clinical medicine in grade 2016 of Fujian Medical University were selected. The first 7 chapters of the course were taught by the traditional lecture style and the last 6 chapters was taught by Rain Classroom. After the course, the questionnaire survey result was used to evaluate the students' recognition of Rain Classroom and the learning outcomes of Rain Classroom.Results Compared with the traditional lecture style, 85.4%(82/96)of the students choose Rain Classroom, 93.8%(90/96)of them believe Rain Classroom is helpful for learning,72.9% (70/96) of the students think that Rain Classroom is helpful to activate the classroom atmosphere, 64.6%(62/96)of the students think that Rain Classroom is helpful to improve the efficiency in class, 97.9% (94/96) of the students think that the red envelopes for answering questions can stimulate the learning.Conclusions The Rain Classroom teaching mode can not only construct an active learning an atmosphere to improve the efficiency learning,, but also stimulate the learning. This result is meaningful and need to be shared by faculty in medical schools. References | Related Articles | Metrics

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Preliminary study on the construction of Mini-CEX scoring system of integrated traditional Chinese and western medicine standardization Lu Ping, Zhao Lei, Shen Mengwen, Ding Chunlei, Chen Yang, Qian Fenghua 2020, 40 (8):  606-609.  DOI: 10.3760/cma.j.cn115259-20190729-00605 Abstract ( 42 )   PDF (808KB) ( 19 )   Objective A set of standardized Mini-CEX scoring standards with characteristics of traditional Chinese medicine is planned to be applied to the clinical practice assessment of medical students in our hospital, so as to improve the clinical practice and assessment efficiency.Methods From January 2016 to December 2016, 40 students of 2012 five-year program of Shanghai University ofTraditional Chinese Medicine majoring in Integrated Traditional Chinese and Western Medicine, who were interned in Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, were divided into standardized group and traditional group by random number table method, with 20 students in each group. The standardization group implements the standardized Mini-CEX assessment method, while the traditional group implements the traditional Mini-CEX assessment method. Statistical analysis of the two groups of students assessment results, and students and teachers of the questionnaire survey results were analyzed.Results The Mini-CEX score of standardized group was lower than that of traditional group[(2.45±0.88)vs(4.65±0.67), P<0.01]. Compared with the traditional assessment method of mini CEX, teachers scored higher on standardized Mini-CEX in terms of “clear scoring basis” [(7.90 ± 0.56) vs (2.90 ± 1.37) , P<0.01]; students scored higher on standardized Mini-CEX in terms of “clearer teacher's comments” and “new experience in TCM consultation method” [(5.95±2.08)vs(1.50±0.60),(4.20±0.69)vs(2.15±1.26), all P<0.01].Conclusions The establishment of standardized Mini CEX scoring standards helps to ensure the fairness and preciseness of assessment and education and teaching, so as to improve the quality of teaching. References | Related Articles | Metrics

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The implementation of Wechat-based continuing medical education system for health-care workers in the battle against COVID-19 pandemic Wu Xueji, Wang Hui, Zhang Yuhua, Mao Ji, Liu Yuqing, Jing Qinlong, Luo Lei, Zhang Zhoubin 2020, 40 (8):  610-614.  DOI: 10.3760/cma.j.cn115259-20200327-00440 Abstract ( 49 )   PDF (797KB) ( 22 )   Objective To implement a Wechat-based continuing medical education system (Wechat-based CMES) for health-care workers (HCWs) in grass-roots control and prevention for COVID-19 and evaluate its effectiveness.Methods Five types of e-courses were designed and uploaded to the system. Data for learning and passing quizzes of HCWs who actively logged in the system with Wechat accounts from Feb 19th to Mar 5th, 2020 was collected and analyzed by chi square test, non-parametric test and logistic regression. The actual cost of the Wechat-based CMES was compared to the estimated cost of the on-site CME as well.Results The person time of HCWs who participated in studying e-courses and passed the quizzes were 26 939 and 52 784 respectively. The comment from HCWs on the e-courses was mainly “practical”. HCWs spent 96 minutes by an accumulate time for learning, reviewing and passing the quizzes using the Wechat-based CMES, however, they would have to spend 480 minutes for the same learning and passing the quizzes using the on-site CME.The full mark rate of quizzes of the 5 types of courses is 42.3% (22 309/52 748). Of the five courses,the course “field epidemiological investigation” has the highest full mark rate of 47.3% (5 869/12 421), the most learners of 12 421 person times and the longest exam time of 4.8 minutes per person time.Logistic regression shows that both quiz types and quiz time have effect on the full mark rate. The costs of on-site CME(4.73 thousand) was 47.6 times than that of the wechat-based CMES(0.996 thousand).Conclusions The use of Wechat-based CMES helps HCWs to learn actively and master the training content through repeated study and examination. Compared with the on-site CME, the Wechat-based CMES is more cost-effective. References | Related Articles | Metrics

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Application of dental operating microscopes to the experimental teaching in operative dentistry and endodontics Quan Jingjing, Liu Hongyan, Mai Sui, Huang Yihua, Xu Zhezhen, Lei Shuxiang, Han Yuqing, Wei Xi 2020, 40 (8):  615-618.  DOI: 10.3760/cma.j.cn115259-20190915-00757 Abstract ( 83 )   PDF (814KB) ( 52 )   Objective To explore the role of dental operating microscopes in the experimental teaching of operative dentistry and endodontics.Methods From October 2017 to January 2018, 76 five-year program dental students enrolled in 2014 from Guanghua School of Stomatology, Sun Yat-sen University were selected as the research objects. All students were randomly divided into 2 groups (group A or B) with 38 students for each group. The dental operating microscopes were applied to experimental teaching of G.V.Black Class I preparation and access preparation, and all students were evaluated by teachers with or without dental operating microscopes. Questionnaire was designed to evaluate the experience of students in using dental operating microscopes.Results The average score of cavity preparation for students using dental operating microscope were (90.16 ± 3.01), while for students without using dental operating microscopes were (90.72 ± 2.57). The differences were not statistically significant (P>0.05). The average score of access preparation for students using the dental operating microscopes were (92.30 ± 2.82), while for students without using dental operating microscopes were (88.93 ± 2.31). The differences of scores were statistically significant (P＜0.05). According to the questionnaire feedback shows that89.3%(67/75) of the students believe that the application of dental operating microscope is helpful in learning clinical operation skills, 29.3%(22/75) of the students feel difficult in the adjust and use of dental operating microscope.Conclusions The application of dental operating microscope is useful for improving students' level of access preparation. Students still need special training and teaching guidance to skillfully use oral operating microscope. References | Related Articles | Metrics

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The application of Sudoku grid endodontic access opening on molar in experimental teaching Jin Chenxin, Hao Xin, Sun Cuicui, Liu Yimeng, Wang Yilin, Xiao Mo, Wang Fei, Wu Ligeng 2020, 40 (8):  619-622.  DOI: 10.3760/cma.j.cn115259-20200410-00511 Abstract ( 49 )   PDF (813KB) ( 21 )   Objective To compare the learning outcomes of Sudoku grid endodontic access opening (SEO) and that of traditional endodontic access opening (TEO) on the training of endodontic access opening skills for undergraduates.Methods Twenty-two undergraduates receiving endodontic access opening training for the first time were selected. The self control experiment was conducted on the students performing SEO and TEO on the artificial teeth and extracted teeth of the first molar, respectively. The time needed for completion of access opening was recorded respectively. The results were then scored according to the standard of endodontic access opening. The statistical analysis was carried out finally.Results On the artificial teeth, the operating time of TEO than SEO was [33.0(26.3, 48.8)] vs [20.0 (12.3, 24.0)]; the score/ time of them was [0.3 (0.2, 0.5)] vs [0.7(0.5, 1.0)]. On the extracted teeth, the operating time of TEO than SEO was [40.0(30.0, 60.0)] vs [24.0 (18.0, 35.0)]; the score/ time of TEO than SEO was [0.2 (0.1, 0.3)] vs [0.4(0.3,0.6)]. All the differences were statistically significant (P<0.05).Conclusions At the initial stage of endodontic access opening skills training,SEO method significantly improves trainees' operant level faster than TEO method References | Related Articles | Metrics

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Exploration on remodeling of clinical practice training based on organ system Zhou Qing, Tang Dong, Yuan Fang, Li Li, Shi Wei, Sang Aimin, Shi Yaqin, Gao Jianlin 2020, 40 (8):  623-627.  DOI: 10.3760/cma.j.cn115259-20190807-00644 Abstract ( 85 )   PDF (799KB) ( 56 )   Objective To explore the outcomes of the remodeling clinical practice training based on organ system.Methods From June 2017 to May 2019, totally 147 interns of five-year curriculum of clinical medicine enrolled in 2013 and 2014 in Nantong University and Suzhou University were selected as the research objects. Totally 74 interns enrolled in 2014 grade were set as the experimental group,the organ-system based learning was adopted. In addition to bedside teaching, the team-based learning was also applied. The 73 interns enrolled in 2013 were set as the control group, with discipline-based training methodology and the bedside teaching model. Through examination scores Mini-CEX score of the two groups of interns and the questionnaire survey of the experimental group of interns, the effect of the reform of teaching mode was evaluated.Results The results of the experimental group and the control group in theoretical knowledge test were [74.24 ± 7.21) vs (68.23 ± 7.86)], clinical skill operation test[ (89.68 ± 5.36) vs (85.29 ± 4.37)], medical record writing[ (94.45 ± 2.78) vs (87.29 ± 4.05)] and Mini-CEX total score [(28 (25, 30) vs 22 (21, 24)], thedifferences werestatistically significant (All P < 0.01). The questionnaire result showed that 81.1% (60 / 74) of the interns in the experimental group affirmed and praised the “organ-system based” clinical practice teaching mode and effect.Conclusions The remodeling of clinical practice training based on organ system is conducive to improving the learning outcomes and practice quality of interns, and has been recognized by interns. References | Related Articles | Metrics

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The post competence oriented capacity building of candidates for master degree in psychiatry and mental health Chen Min, Dong Man, Feng Yu, Gao Yan, Yu Hao, Zhai Jinguo, Ji Feng, Li Gongying, Su Zhonghua, Wang Guishan 2020, 40 (8):  628-631.  DOI: 10.3760/cma.j.cn115259-20200201-00101 Abstract ( 50 )   PDF (779KB) ( 27 )   Mental disorder affect people's physical, mental health and quality of life seriously. At present, there are few high-level and applied mental health talents in China. So it is very important to cultivate graduates for professional degree. In this article, the cultivation model of the graduates for professional degree of psychiatry and mental health based on competency in Jining Medical University is described. It was pointed out that the university emphasize the capacity building, especially the clinical practice skill in the field of psychiatry. It was explored the cultivationObjective, the standardized training of clinical ability, the establishment of the assessment system, the construction of the professional teaching team and the improvement of the graduate education management mode. The aim is to cultivate qualified high-level professional degree postgraduates of psychiatry and mental health. References | Related Articles | Metrics

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Student engagement and its impact on learning outcomes of undergraduates of clinical medicine Fan Yujie, You You, Li Feng, Wang Weimin, Chen Juan 2020, 40 (8):  632-636.  DOI: 10.3760/cma.j.cn115259-20191216-01088 Abstract ( 83 )   PDF (831KB) ( 55 )   Objective This study aims at exploring influences of medical students' learning outcomes based on the theory of student engagement.Methods A questionnaire was distributed to 174 students majoring in clinical medicine in grade 2014 at Peking University Health Science Center in June 2019. A multilevel model was applied to analyze the results.Results For student inputs variables, the metacognitive strategy (β = 0.058, P <0.01), emotional input (β = 0.040, P = 0.013), extracurricular learning input (β = 0.006, P<0.01) influence grade point average (GPA), and the effects have no change with academic stage. The influence of scientific research input time on GPA is moderated by academic stage. Effects of scientific research input change from negative to positive along with the change of academic stage (e.g., from the pre-medical, basic medicine and clinical stages). For school inputs variables, only equipment and facilities have a significant influence on GPA, and a positive relationship is only found in clinical medical stage.Conclusions Students' metacognitive strategies and emotional input play the greatest role in improving their learning outcomes. The physical environment alone does not necessarily promote students' learning. References | Related Articles | Metrics

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Investigation and analysis of the implementation effect of “process assessment + final assessment” assessment system in pathophysiology teaching based on the perspective of students Cong Xin, Zhang Yan, Xu Hai, Liu Limei, Zheng Ming, Xiang Ruolan, Cai Jingyi, Wu Liling 2020, 40 (8):  637-640.  DOI: 10.3760/cma.j.cn115259-20191011-00842 Abstract ( 59 )   PDF (775KB) ( 34 )   Objective To evaluate the “process assessment + final assessment” assessment system in pathophysiology from the perspective of students.Methods A total of 570 students from Peking University in clinical medicine, basic medicine, stomatology, preventive medicine, medical English, nursing and medical experiments in 2016 were selected as the research objects,we conducted a questionnaire survey from multiple aspects,including assessment effect,assessment content and performance,self-writing scenario simulation or case analysis questions,and impact on learning pathophysiology.Results 95.0% (541/570) students suggested to continue to use “process assessment + final assessment” in the course of pathophysiology in the future;92.9%(530/570)students believed that the assessment methods of case analysis and situational multiple choice questions played a role in understanding and using theoretical knowledge; 88.9% (507/570) students agreed with the assessment methods of situational multiple choice questions or case analysis written by their classmates. The novel assessment system not only helps students to review and consolidate basic knowledge (6.97), analyze problems with learned knowledge (4.64), and integrate basic and clinical knowledge (3.94), but also helps to improve students' abilities of autonomous learning (2.58) and team cooperation (1.42).Conclusions Students think that a reasonable and effective assessment and evaluation system will provide solid foundation to improve student attainment. References | Related Articles | Metrics

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Utilizing the generalizability theory to improve the clinical skills assessment design Liang Haifei, Pan Guichang, Gong Jianfeng, Ding Weiren, Zhou Haibo 2020, 40 (8):  641-644.  DOI: 10.3760/cma.j.cn115259-20190715-00553 Abstract ( 28 )   PDF (996KB) ( 21 )   Objective Generalizability theory was utilized to determine optimal clinical skills assessment designs, which reduce errors and improve reliability.Methods Forty resident doctors acted as the study participants which were in their second year of residency training at the Sixth Affiliated Hospital of Guangzhou Medical University in 2018. Items in the clinical skills assessment included abdominocentesis, tracheal intubation, cardiac physical examination, debridement and suturing, and thoracentesis. Two scorers per station were calculated and analyzed using generalizability theory.Results The results from the multivariate analysis of variance and generalizability theory showed that the total variance was 268.106 and the variance component interpretation percentages were 39.9% (research subject, 106.936/268.106), 6.8% (assessment station, 18.190/268.106), 0.0% (scorer, 0.000/268.106), 41.9% (research subject and assessment station, 112.395/268.106), 0.0% (research subject and scorer, 0.000/268.106), 1.8% (assessment station and scorer, 4.838 /268.106), and 9.6% (residual, research subject and assessment station and scorer, 25.747/268.106). When adding test stations or scorers, their generalization coefficient and independent index values (these two indicators represent the reliability value of the test) increase until a certain point is reached; at that point, by adding test stations or scorers, the rate of increase of the generalization coefficient and the independent index value decrease.Conclusions To obtain the most reliable formative evaluation, eight test stations should be designed, with one scorer at each test station; 12 credential stations should be designed for the most reliable final evaluation, with two scorers at each test station. References | Related Articles | Metrics

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The utilization of transformative learning theory in nursing education in the US and Canada and its implications to China Hou Jianlin, Zhou Dandan, Luo Youhui, Yan Minghui, Wang Weimin 2020, 40 (8):  645-648.  DOI: 10.3760/cma.j.cn115259-20190329-00228 Abstract ( 81 )   PDF (781KB) ( 33 )   Objective To introduce transformative learning theory in nursing education in the United States and Canada and identify its implications to China.Methods Literature review was conducted to summarize the utilization of transformative learning theory in nursing education in the United States and Canada.Results In the United States and Canada, transformative learning theory has been increasingly utilized for shaping nursing education and provided theoretical guidance to nursing education reform and innovations. Comparing with traditional teaching approaches, transformative learning has its unique advantages in transforming nursing students' cognition and strengthening the development of competence building, which may futher promote the cultivation of nursing students' competence, including critical thinking and professionalism.Conclusions Transformative learning theory has exerted important influences on nursing education and innovations in the United States and Canada. It may be necessary to introduce and promote the theory in China in order to improve the quality of nursing workforce training and gradually fill the gap with the international advanced standard of nursing education. References | Related Articles | Metrics

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Target-driven curriculum innovation: exploring the medical education reform in the United States Tang Lin, Gui Hang 2020, 40 (8):  649-653.  DOI: 10.3760/cma.j.cn115259-20191218-01097 Abstract ( 132 )   PDF (797KB) ( 97 )   Initiated with a brief introduction of the current medical education system in the United States, this article elaborates on pedagogy transformations and curriculum redesign based on Harvard Medical School, Stanford University School of Medicine and Johns Hopkins School of Medicine's reform. Gaining insight into the trainingObjectives, educational philosophy, clinical immersion and professionalism cultivation of these world-class medical schools may inspire us to explore more strategic and rational approaches. We highlight some key points such as to restore the medical education continuum, advocate the contemporary focus of reform, reconstruct the curriculum design and evaluation system, and to consolidate the training goals in medical schools., which will strengthen the medical education reform in China. References | Related Articles | Metrics