京都大学 / 0048 / 新制・課程博士 / 博士(教育学) / 甲第20126号 / 教博第203号 / 新制||教||167(附属図書館) / 京都大学大学院教育学研究科教育科学専攻 / (主査)教授 松下 佳代, 准教授 田口 真奈, 教授 溝上 慎一 / 学位規則第4条第1項該当 / Doctor of Philosophy (Education) / Kyoto University / DGAM

Introduction: The objective of this study was to measure virtually-based objective structured clinical exam (OSCE) pass rates of student pharmacists who received remote, synchronous instruction on medication reconciliation compared with OSCE pass rates from the previous class, who received face to face synchronous instruction and OSCEs. The secondary objective was to measure student perceptions of remote instruction and OSCE preparation. Materials and Methods: Second year student pharmacists attended four online preparatory labs to learn and practice the process of performing a medication reconciliation. A virtually-based OSCE was used to assess student competency of identifying the primary or life-threatening medication related problem (MRP). Failing to identify the MRP represented a “kill point” and an automatic failing grade. A brief 10-item survey designed to measure student perceptions was sent to all participants post OSCE. Results: Seventy-seven students completed the OSCE and the overall pass rates were similar between the 2020 and 2019 class years (97% vs 94%, respectively; p = 0.24). Survey responses showed students lacked confidence, preferred face-to-face learning rather than online and most described their remote environments as not conducive to learning. Conclusion: Online instruction and assessment was at least as effective as traditional face-to-face methods. however the virtual-based platform was not preferred by learners.

Abstract available in the American Journal of Pharmacy Education.

Syftet med denna studie var att jämföra tandläkarstudenters reella resultat på en Objective Structured Clinical Examination (OSCE) med deras egenskattade resultat. Dessa resultat jämfördes sedan med avseende på genus. Ett flertal studier finns publicerade där man har beskrivit skillnader i självvärdering mellan kvinnor och män på teoretiska examinationer. Dock saknas kunskap där man granskar dessa skillnader vid examination av kliniska moment. Vid teoretiska prov har man funnit att män har en tendens att värdera sina prestationer högre än vad kvinnor gör. Om dessa skillnader i självvärdering beror på överskattning hos män, underskattning hos kvinnor, en kombination av båda eller att värderingen faktiskt överensstämmer med de verkliga resultaten varierar mellan olika studiers resultat. Samtliga elever (35 kvinnor och 16 män) på sjätte termin på Odontologiska fakulteten på Malmö högskola examinerades med en OSCE bestående av 13 stationer. Studenternas reella resultat på OSCE jämfördes med deras självvärdering för varje station. Kvinnliga och manliga studenters bedömningar jämfördes. På de flesta av de 13 stationerna förekom inga signifikanta skillnader i över- och underskattning mellan kvinnor och män. Män hade svårare än kvinnor att korrekt värdera sin prestation gällande avtryckstagning med alginat. Dessa missbedömningar berodde främst på överskattning. Ingen tendens till att kvinnor underskattade sin prestation i större utsträckning än män kunde konstateras. Till skillnad från studier där man undersöker genusskillnader i självvärdering vid teoretiska examinationer fann man i denna studie inga signifikanta skillnader i över- och underskattning mellan könen. / The objective of this study was to compare dental student’s results at an Objective Structured Clinical Examination (OSCE) with their self-assessed results. These results were compared depending on gender. There are several studies published comparing gender differences in self-assessment in theoretical written exams. However there is a lack of knowledge regarding clinical examinations. At theoretical examinations it has been found that men tend to over-estimate their performance more frequently than women do. Whether these differences in self-assessment exist because men tend to over-estimate themselves, women tend to under-estimate themselves, a combination of both or the self-assessment is consistent with the result at the examination vary between different studies. All students (35 women, 16 men) at the Faculty of Odontology, Malmö University (sixth semester) were examined with an OSCE with 13 stations. The student’s real results at OSCE were compared with their self-assessed results at each station. The assessments were compared regarding gender. At most of the 13 stations there were no significant differences in over- and under-estimation regarding women and men. It was more difficult for men to assess their performance regarding impression with alginate, this difference was statistically significant. These misjudgments were mainly caused by over-estimation. There were no results indicating that women under-estimate their performance at greater extent than men. As opposed to studies where gender differences concerning self-assessment in theoretical examinations are studied, there were no significant differences in over- and under-estimation between genders in clinical examination evaluated in the present study.

We conduct an evaluation of the cross-cultural ‘export’ of the Objective Structured Clinical Examination (OSCE), a well-established Western medical education assessment tool that is in keeping with Competency-Based Medical Education (CBME) principles, into the new socio-economic setting of Rwanda. The evaluation framework of ‘assessment utility’ is applied, where the utility of an assessment is described conceptually as the multiplicative function of its validity (V), reliability (R), educational impact (E), cost/feasibility (C) and acceptability (A). A mixed-methods approach of both quantitative and qualitative data analysis is used. The quantitative findings support high content and face validity, high reliability, high acceptability and achievable cost and feasibility of the OSCE, all of which would suggest high utility. The analysis of qualitative data identifies some important threats to validity, namely perceived significant gaps in training in the internship program that were thought to likely be the underlying reason for the low mean assessment scores. This threat to the validity of the results appears to influence and limit the acceptability of the assessment in this context. While it is believed that it would be suitable as a formative assessment, primarily for the purpose of ‘assessment for learning’, it was not felt that it was currently acceptable as a summative or high-stakes ‘assessment of learning’, until and unless training deficits are addressed. Currently, the OSCE is seen to have greatest value in its potential for educational impact by acting as both a driver and a marker for change both at the individual and programmatic levels. Many principles of CBME and the concept of ‘entrustability’ as a criterion-referenced assessment standard were well-received cross-culturally, when training and assessment were viewed in tandem. Our study highlights the importance of using a comprehensive evaluation framework that includes both quantitative and qualitative methods to accurately characterize the utility of an assessment. / Thesis / Master of Science (MSc) / This is a case-study where the Objective Structured Clinical Examination (OSCE), a well-established, performance-based and resource-intensive Western medical education assessment tool, was introduced to the culturally different, resource-limited setting of Rwanda. What we wanted to evaluate is how the OSCE was received in the Rwandan medical training system. What we found is that generally, the OSCE was received in a positive way. Both examiners and participants thought it was a relevant, realistic, feasible, valuable test for doctors in training. However, examiners also felt that the candidates did not do as well as they could have on the test not because they were fundamentally bad doctors, but because there were major gaps in their training. The OSCE therefore demonstrated its usefulness by identifying these deficiencies in training. Examiners felt that addressing these gaps in training was most important and should be done before any institutional body uses the OSCE results to decide who should get a medical license or not.

Purpose: The Standardized Patient [SP] Program is a potential avenue through which students from races and ethnicities underrepresented in medicine [URiM] experience bias, due in part to the inherent subjectivity of an SP’s evaluation of the doctor-patient interaction. In most training programs, medical students are assessed on their clinical and interpersonal skills via simulated encounters where students assume the doctor role and SPs act as patients. Researchers conducted this qualitative study to (1) understand the SPs’ perception of their role within the Objective Structured Clinical Exam and medical school education, (2) investigate biases that medical students may experience during SP evaluations of simulated clinical encounters.Methods: Participants were recruited from Lewis Katz School of Medicine at Temple University. Interviews and focus groups were conducted between August through October of 2022. A total of 14 medical students, 11 of which self-identified as URiM, were distributed into 6 focus groups. A total of 9 SPs were interviewed, 3 of which self-identified as non-white ethnic minorities. All interviews were then transcribed and analyzed using a combination of first-cycle coding methods. In the final stages of analysis, we examined the data to determine frequent themes across the study populations. Results: The results demonstrated conflicting sentiments between SPs and students. Although SPs described an intensive training process that promoted standardization of DPI scoring across SPs, URiM students reported high interrater variability, referring to the variation in the interpretation of a student’s communication skills by SPs. The consensus amongst minority students was that SPs evaluate students more leniently in interactions where the SP and student share ethnic identities. The themes present in the resulting data aligned closely with a social determinants of health conceptual framework, illustrating how disregarding the topic of implicit bias in the SP Program leads to a downward trajectory of differential attainment. Conclusion: Although medical education administrators have begun shifting their attention towards diversity, equity, and inclusion initiatives, there has been minimal focus on the key perspectives necessary to navigate this space. Our research analyzes those perspectives as an important first step towards acknowledging and effectively mitigating bias in medical education programs. / Urban Bioethics

Nel corso della sua lunga storia la Santa Sede è sempre stata protagonista attiva delle relazioni tra popoli, regni, Stati e nazioni. Un ruolo importante viene da essa svolto anche nel '900, specialmente a partire dalla Prima Guerra Mondiale, nell'ambito del tentativo di costruire un nuovo ordine internazionale fondato più sulla forza del diritto che sul diritto della forza. L'Enciclica Pacem in Terris ed il Concilio Vaticano II segnano l'inizio di un più deciso appoggio alla diplomazia multilaterale ed alle organizzazioni internazionali, specialmente ONU e CSCE-OSCE, come si può vedere nel caso della Prima Crisi del Golfo (1990-1991) e della dissoluzione della ex Jugoslavia (1991-1999). La Santa Sede elabora così, progressivamente, un proprio concetto di nuovo ordine internazionale, fondato sul diritto, sulla parità giuridica, sulla uguaglianza sostanziale degli Stati, dotato di un'Autorità centrale imparziale, a carattere democratico, in grado di imporre il rispetto di determinati principi fondamentali per una pace duratura, nella piena osservanza del principio di sussidiarietà. Un ideale ancora lontano dall'essere raggiunto. / Along his long history the Holy See has always played an important role in the relations between kingdoms, States and nations. This role remains important also in the 20th century, especially from World War One, in the pursuit of a new international order based more on the force of right than on the right of force. The Encyclical Pacem in terris and the II Vatican Council are the beginning of a deeper support to multilateral diplomacy and international organisations, particularly UNO and CSCE-OSCE, as it may be noticed during the First Gulf War (1990-1991) and the dissolution of former Yugoslavia (1991-1999). Thus, the Holy See has gradually developed a concept of new international order based on human rights and international law, juridical equality of all States, and on a central, impartial Authority capable of enforcing the respect of a given set of fundamental principles which are essential for the maintenance of peace, in the respect of the principle of subsidiarity. An ideal still far from reality.

No description available.

This thesis investigates the role of regional organizations in peacemaking and peacekeeping, particularly on the effects of peace agreement duration. This is important because the United Nations has been traditionally seen as the default international peacekeeping force but recently, more responsibility is being given to regional organizations. This study hypothesizes that regional organizations’ ability to clear commitment problems, create specific agreements, and willingness to enforce agreements make them the most effective third parties to deal with many conflicts. However, the study also hypothesizes that regional organizations are less fit to mediate conflicts based around ethnicity, identity, or religious disparities. By utilizing a mixture of logistic regression and case studies, the results illustrate that regional organizations are an essential asset to creating agreements that elongate the duration of peace. In testing for the partiality of regional organizations, the specifics of agreements made, the willingness and capabilities of enforcement, the reason for the conflict and the institutionalization of the organization, quantitative and qualitative results illustrate that regional organizations are a valid tool for conflict management

<p>This thesis deals with cooperation between France, Germany and the United Kingdom within the area of foreign and security policy. Two case studies are presented, one of them concerning cooperation between the three states within and outside institutions in 1980 following the Soviet invasion of Afghanistan, and the other dealing with cooperation concerning the crisis in Macedonia in 2001. In accordance with the approach of neoliberal institutionalism the primary hypothesis is that cooperation is primarily determined by the interests of states but it is also limited by norms and affected by the institutions of which the three states are members. The study describes the large variety of forms of cooperation that exist between France, Germany and the United Kingdom, in which the United States also plays an important part, and which also includes their cooperation within a number of international institutions. The study also points to the new forms of interaction between states and institutions that have come about since the Cold War ended, and which give a stronger role to institutions and the cooperation between them. Still, however, states retain a decisive role in cooperation within the field of foreign and security policy.</p>