Korean Journal of Family Medicine

Comparison of Patient-Physician Interaction Scores of Clinical Practice Examination between Checklists and Rating Scale: Nam Eun Kim, Hoon Ki Park, Kyong Min Park, Bong Kyung Seo, Kye Yeung Park, Hwan Sik Hwang; Korean J Fam Med 2018;39(2):96-100. Published online March 22, 2018; DOI: https://doi.org/10.4082/kjfm.2018.39.2.96

Abstract
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Background

The clinical practice examination (CPX) was introduced in 2010, and the Seoul-Gyeonggi CPX Consortium developed the patient-physician interaction (PPI) assessment tool in 2004. Both institutions use rating scales on classified sections of PPI but differ in their scoring of key components. This study investigated the accuracy of standardized patient scores across rating scales by comparing checklist methods and verified the concurrent validity of two comparable PPI rating tools.

Methods

An educational CPX module dyspepsia case was administered to 116 fourth-year medical students at Hanyang University College of Medicine. One experienced standardized patient rated exams using two different PPI scales. She scored checklists composed of 43 items related to the two original PPI scales through video clips of the same students. From these checklists, we calculated Pearson's correlation coefficient.

Results

The correlations of total PPI score between the checklist and rating scale methods were 0.29 for the Korean Medical Licensing Examination (KMLE) tool and 0.30 for the consortium tool. The correlations between the KMLE and consortium tools were 0.74 for checklists and 0.83 for rating scales. In terms of section scores, the consortium tool showed only three significant correlations between the two methods out of seven sections and the KMLE tool showed only two statistically significant correlations out of five sections.

Conclusion

The rating scale and checklist methods exhibited a weak relationship in the PPI assessment, but a high correlation between assessment tools using the same method. However, the current rating scale requires modification by reorganizing key scoring components through factor analysis.

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Development of the Perceived Stress Inventory: A New Questionnaire for Korean Population Surveys: Eon Sook Lee, Ho Cheol Shin, Jun Hyung Lee, Yun Jun Yang, Jung Jin Cho, Gwiyeoroo Ahn, Yeong Sook Yoon, Eunju Sung; Korean J Fam Med 2015;36(6):286-293. Published online November 20, 2015; DOI: https://doi.org/10.4082/kjfm.2015.36.6.286

Abstract
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Background

Given emerging evidence of the association between stress and disease, practitioners need a tool for measuring stress. Several instruments exist to measure perceived stress; however, none of them are applicable for population surveys because stress conceptualization can differ by population. The aim of this study was to develop and validate the Perceived Stress Inventory (PSI) and its short version for use in population surveys and clinical practice in Korea.

Methods

From a pool of perceived stress items collected from three widely used instruments, 20 items were selected for the new measurement tool. Nine of these items were selected for the short version. We evaluated the validity of the items using exploratory factor analysis of the preliminary data. To evaluate the convergent validity of the PSI, 387 healthy people were recruited and stratified on the basis of age and sex. Confirmatory analyses and examination of structural stability were also carried out. To evaluate discriminatory validity, the PSI score of a group with depressive symptoms was compared with that of a healthy group. A similar comparison was also done for persons with anxious mood.

Results

Exploratory factor analysis supported a three-factor construct (tension, depression, and anger) for the PSI. Reliability values were satisfactory, ranging from 0.67 to 0.87. Convergent validity was confirmed through correlation with the Perceived Stress Scale, Center for Epidemiologic Studies Depression Scale, and State-Trait Anxiety Inventory. People with depressive or anxious mood had higher scores than the healthy group on the total PSI, all three dimensions, and the short version.

Conclusion

The long and short versions of the PSI are valid and reliable tools for measuring perceived stress. These instruments offer benefits for stress research using population-based surveys.

Citations

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The Effect of Family Member's Attendance on Relief of Patient's Discomfort during Upper Gastrointestinal Endoscopy.: Jong Yoon Yoo, Sang Keun Hahm, Jung Yoon Chun, Sang Hyuk Lee, Seong Hwan Cho, Jin A Park; J Korean Acad Fam Med 2008;29(1):13-19. Published online January 10, 2008

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The Current Educational Measurement of Family Practice Residents.: Min Jeong Kim, Ho Cheol Shin, Cheol Hawn Kim, Youn Seon Choi, Hang Lee, Ae Kyung Choi, Yu Jin Paek, Eon Sook Lee, Jin Ho Park, Yoon Jung Chang; J Korean Acad Fam Med 2007;28(8):616-625. Published online August 10, 2007

Abstract
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Background
The educational assessment of residents is very important in order to check their knowledge and to improve their ability. In case of family practice, the residents spend most of their training time in outside rotations with other specialities. Therefore, they are requested to be evaluated by each specialist after each rotation. To give more accurate assessment, we surveyed directly our family practice residents and family practice faculties. Methods: A questionnaire was sent to family practice residents and family practice faculties in 116 hospitals from May to June 2006. The response rate was 29% and 78%, respectively. Results: Among the total, 70.2% of family practice residents thought an assessment is necessary, but only 51.7% were evaluated. Overall, 90.4% of family practice faculties knew about the assessment of residents made by other specialists, and only 56.7% of faculties requested other specialists to assess their family practice residents. Conclusion: Most of the family practice residents and their faculties knew the need for assessment, but they complained there were no objectivity and the assessment tool was lacking. In order to solve this problem, it is urgent to develop a unified form and guidelines of assesment. (J Korean Acad Fam Med 2007;28:616-625)

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Suitability Assessment of Patients' Education Materials Made by Korean Academy of Family Medicine.: Nak Jin Sung, Dong Uk Lee, Ki Heum Park; J Korean Acad Fam Med 2004;25(9):669-677. Published online November 5, 2004

Abstract
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Background
: We assessed the suitability of patients' education materials made by KAFM (Korean Academy of Family Medicine) to suggest guidelines for making more efficient education materials.

Methods : The Korean version of SAM (Suitability Assessment of Materials) was used to evaluate patients' education materials of KAFM. The Korean version was modified within the centext of Korean language and culture by 3 family medicine specialists. We evaluated all materials which had been made up to October, 2003. Each item of evaluation criteria was assessed and agreed by 3 family medicine specialists.

Results : The total number of evaluated materials as 51. The average SAM score was 40.2% and its range was 22∼78%. The materials on 'Early detection and self examination of breast cancer', 'Back muscle exercise for back pain patients', and 'Treatment and management of hypertension' received high scores. The materials on 'TIA', 'Alcohol and liver', and 'Children's constipation' received low scores. Two materials (3.9%) were judged excellent, 18 (35.3%) adequate, and 31 (60.8%) not adequate. The criteria for each item such as learning aids via road signs, layout factors, and typography received high scores. The criteria for each item such as summary or review included, 'context is given first', 'cover graphic shows purpose', relevance of illustrations, and 'caption used for graphics' received low scores.

Conclusion : The items such as 'learning aids via road signs', 'layout factors', and 'typography' received high scores in the evaluation of patients' education materials by SAM criteria. There were also weak points noted about unclear purpose, less description about behavior change, irrelevance of illustrations, and lack of learning stimulation and motivation.

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Knowledge and Skills in Blood Pressure Measurement Skills.: Seon Ho Min, Seung Yeon Lee, Hong Jun Cho; J Korean Acad Fam Med 2003;24(7):629-633. Published online July 10, 2003

Abstract
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Background
: Errors during measurement of blood pressure can cause over diagnosis or under diagnosis of hypertension, which can result in inappropriate management of hypertension and follow up consultation. The aim of this study was to investigate the factors affecting the accuracy of blood pressure measurement, which may serve as means to improve the accuracy of blood pressure measurements.

Methods : Among the 123 interns who work at Asan Medical Center, we selected 90 persons who agreed to join the study. Three interns were excluded because of their incomplete response to the questionnaire. Questionnaire for the survey concerning blood pressure measurement was created by selecting 5 case problems from a total of 34 cases provided within the blood pressure measurement CD ROM, which apply the Korotkoff sound technique. The factors that might affect the measurement were analyzed by multiple logistic regression.

Results : Fifteen (17.2%) interns failed to accurately measure blood pressure provided by the CD program. They showed a difference of greater than 10 mmHg between the actual and the measured systolic blood pressure. A discrepancy of greater than 5 mmHg was noted in the measurement of diastolic blood pressure. From the total sample of 87 interns, 15 (16.1%) interns showed digit preference (0 or 5), when measuring blood pressure. The discrepancy between the measured and the actual blood pressure was greater among those who had a digit preference (95% CI 1.055∼17.770).

Conclusion : Digit preference was the most important factor that affected the accuracy of blood pressure measurement taken by conventional sphygmomanometry. Effort to correct digit preference would improve the quality of blood pressure measurements.

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The Self Blood Pressure Measurement by Hypertensive Patients: a Patient Survey.: Dong Ryul Lee, Woo Kyung Bae, Sang Min Park, Yoon Jung Chang, Kyu Nam Kim, Be Long Cho; J Korean Acad Fam Med 2003;24(1):45-50. Published online January 10, 2003

Abstract
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Background
: This study was designed to compare the usual self-checked blood pressure measuring methods by hypertensive patients with standardized methods.

Methods : From May to August 2002, we surveyed 137 hypertensive patients who performed self blood pressure measurements with a self-administered questionnaire. We defined 14 standard methods from the six most frequently recommended guidelines. We asked patients how often they calibrated their sphygmomanometer, and how they learned to measure blood pressure. Also, their upper arm circumferences were measured.

Results : The percentage of correct preparations for BP measurement was over 80%, but that of correct technique was low. For example, 'reading from the arm with higher BP by more than 10 mmHg' (4.4%), 'placing midline of the bladder over the arterial pulsation' (21.5%), and 'waiting 2 or more minutes between readings' (21.9%). Only 11.2% of the patients have ever had calibrated their sphygmomanometers. In 20.2% of hypertensive subjects, upper arm circumferences were greater than 30 cm which made blood pressure measurement with a 24 cm-sized bladder incorrect.

Conclusion : As shown in previous studies, the methods of blood pressure measurement were incorrect in many aspects. Therefore, systematically educating hypertensive patients to measure blood pressure by correct methods and recommending to use a proper-sized cuff are essential.

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The variability of blood pressure according to the number of measurement for diagnosis of hypertension.: Cang Ho Youn, Tae Jung Kwon, Dong Hyun Kim, Jung Bum Lee; J Korean Acad Fam Med 2002;23(1):33-39. Published online January 1, 2002

Abstract
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Background
: Hypertension is a common, chronic disease that poses as a main risk factor of coronary artery disease. Therefore, it requires accurate diagnosis. This study attempted to examine the problem of misclassification and accurate diagnosis of hypertension in primary care settings and to consider the relationship between variability of blood pressure and number of measurements.

Methods : Among the 158 patients with initially high blood pressure who visited health screening center of one university hospital from May to November, 199,97 persons who corresponded to the following conditions were chosen for this study. We classified hypertension as stage 1 and 2. The subjects were not previously diagnosed as hypertensive and had no past history of use of antihypertensive medication. Blood pressure was measured according to 1999 WHO/ISH Hypertension Guideline, and two or more measures were performed at each visit on five separate occasions at one week intervals.

Results : The mean of initial blood pressure was 159.6 mmHg in systole, 95.3 mmHg in diastole. The mean of subsequent blood pressure was 155.6 mmHg, 146.1 mmHg, 143.4 mmHg, 138.7 mmHg in systole and 92.5 mmHg, 88.4mmHg, 87 mmHg, 85.1 mmHg in diastole, which showed the tendency to be lower. In both systole and diastole, the mean differences between first and second measurements, second and third measurements were significant, but insignificant between third and forth measurements, and forth and fifth measurements.
We divided systolic and diastolic pressures ito two subgroups according to stage 1, 2 classification of hypertension. In stage 1 subgroup, the means of blood pressures were lower from 151.3 mmHg to 135.4 mmHg in systole, from 95.1 mmHg to 85.3 mmHg in diastole, but there were not significant. In stage 2 subgroup, the mean blood pressure was lower from 169.7 mmHg to 142.5 mmHg in systole, form 105.4 mmHg to 87.8 mmHg in diastole, and the mean differences between first and second measurements, second and third measurements were significant, but not significant between third and forth measurements, and forth and fifth measurements.

Conclusion : Blood pressure tends to be checked significantly lower until subsequent third measurements, but not thereafter. We think that more studies to find out how many blood pressure measurements are needed for diagnosing hypertension in consideration of patient's blood pressure level and risk factors.