Thực trạng dạy học lâm sàng môn truyền nhiễm và hiệu quả can thiệp bằng sử dụng bệnh án điện tử tại đại học y khoa vinh tt tiếng anh

MINISTRY OF EDUCATION MINISTRY OF HEALTH AND TRAINING HANOI MEDICAL UNIVERSITY NGO TRI HIEP THE CURRENT SITUATION OF CLINICAL TEACHING OF INFECTIOUS SUBJECT AND INTERVENTION EFFECTIVE

MINISTRY OF EDUCATION MINISTRY OF HEALTH AND TRAINING

HANOI MEDICAL UNIVERSITY

NGO TRI HIEP

THE CURRENT SITUATION OF CLINICAL TEACHING

OF INFECTIOUS SUBJECT AND INTERVENTION EFFECTIVENESS BY USING ELECTRONIC MEDICAL RECORD AT VINH MEDICAL UNIVERSITY

Specialization: Social Hygiene and Health Organization

Code: 62720164

SUMMARY OF DORTORAL THESIS

HA NOI – 2020

This thesis was completed at:

HANOI MEDICAL UNIVERSITY

Supervisors:

1 Assoc Prof Trinh Hoang Ha

2 Assoc Prof Nguyen Van Huy

The thesis could be found at:

- Vietnam National Library

- Library of Hanoi Medical University

INTRODUCTION

Clinical teaching (CT) is a special part of medical education in general and teaching of general medical students, in particular CT occupies a large part in training programs of medical universities in the world as well as in Vietnam Throughout clinical practice (CP) process, students are able to apply theoretical knowledge learned to make decisive diagnosis, offer treatment, address situations, monitor and prognose patients

There are many CT methods applied in training for students at the hospital CT by medical record commentary (MRC) and case discussion becomes indispensable methods in medical universities Practicing of the medical record-making skills (MRMS) is one of the solutions to improve the effectiveness and quality of CT

At present, there is a fact that many medical universities still lack a team

of highly qualified lecturers Lecturers also participate in many tasks Besides,

a part of students is still passive, lack of motivation, lack of knowledge, skills, and creativity affect learning efficiency In addition, the change in population structure, disease patterns, hospital regulations, people's intellectual life, the explosion of information tecnology (IT) also directly affects the CT process Researches on CT have been conducted in some universities Researches focus on CT characteristics and improve the effectiveness of CT through applicating of active teaching methods The feasibility of the interventions also depended on the factors and conditions of each university The application of IT in CT has not been fully mentioned and studied Vinh Medical University (VMU) was established in 2010 Since 2011, the University started training medical students In the condition of increasing infectious diseases, training of general practitioners with adequate knowledge and skills on infectious diseases is a requirement for the people's health care From that fact, the question is given that how is the current stuation of infectious CT in the VMU and if can apply IT to create the electronic medical record (EMR) to support medical students in making the medical record (MR) better from which to improve the efficiency and quality of CP process? To find the answers to the above questions, we implemented the application of E-learning technology using Moodle software

to design the EMR for supporting medical students in clinical practice of infectious subject The thesis was implemented for the following objectives:

1 Describe the current situation of clinical teaching of infectious subject for medical students at Vinh Medical University

2 Evaluate the intervention effectiveness by using the electronic medical

record in infectious clinical teaching for medical students at Vinh Medical

University

NEW CONTRIBUTIONS OF THE THESIS

The thesis results provided evidences on the current situation of infectious CT, showed some limitations which affecting the effectiveness of

CT Intervention by using the EMR to help students make infectious medical record (IMR) through E-learning course has achieved certain effectiveness High intervention effectiveness (IE) was recorded in the contents of the MR; the positive evaluation of students on the course, self-evaluation of MRMS have improved better The project is practical, feasible

to overcomes a number of limitations in CT, is suitable with the trend of IT application and meets the needs of the university, lecturers and students The thesis also opens up a new direction in CT that is the application of IT not

only for MRMS but also for other areas

ARRANGEMENT OF THESIS

The thesis consists of 130 pages, excluding appendices, in which: Introduction of 2 pages, an overview of 35 pages of documents, the research methodology of 18 pages, the research results of 36 pages, the discussion of

35 pages, conclusion of 2 pages, recommendations 2 pages The references were written standardly, there were 112 references, including 38 documents updated within 5 years, accounting for 33.9%

CHAPTER 1 OVERVIEW 1.1 Some basic concepts

1.1.1 Medical student

General medical students are students who study to become a general practitioner who treats acute and chronic diseases, proposes preventive measures, rehabilitates health and prescribes medicine for patients

1.1.2 Infectious Diseases

Infectious diseases are diseases that can spread directly or indirectly to surrounding individuals and tend to cause epidemics in population communities

1.1.3 Medical Record

The Medical Record (MR) is a document that records everything necessary for understanding the situation of the patients’diseases from the time of admitting to the time of discharge The MR is done by the physician as soon as possible when the patient enters the hospital and records all the information related to the patient including name, age, address, occupation,

arising status, and disease progression

1.1.4 Infectious Medical Record

The IMR is a MR sample that is formulated when a patient is admitted

to the department of infectious disease The IMR presents the personal patient's information, the patient's condition upon admission, the diagnosis

of the physician, and the patient's examination results

1.1.5 Electronics Medical Record

The EMR is a digital version of a MR, recorded, displayed and stored

by electronic means, with the legal basis and the equivalent function to the paper MR, specified in the Law on Examination and Treatment

1.1.6 Information Technology

IT is an engineering branch that uses computers and computer software

to convert, collect, store, protect, process and transmit information

1.1.7 Terminology concept of E-Learning

E-learning is the process of learning through electronic means, the Internet, and Web technologies The content is distributed to the classrooms via the Internet, Extranet, audiotapes, videos, broadcast satellites, television,

CD - ROM and other electronic media

1.1.8 Moodle concept

Moodle is an open-source online learning management system, also known as Course Management System or Virtual Learning Environment, which allows creating courses on the Internet or online Web pages

1.2 Overview of clinical teaching

1.2.1 The role and goals of clinical teaching

CT often makes up a large proportion of medical staff training programs in medical universities Through CT, students will achieve 3 common goals: 1) Learning attitudes, behaviors, and behaviors 2) Learning knowledge and career skills 3) Training the clinical thinking style, working style of health staff; learning methodology; forming self-study, self-researching, and building the working capacity

1.2.2 The features of clinical teaching

CT takes place in hospitals, clinics, and is closely related to the task of healthcare for patients The relationship between teachers and students will motivate students to behave more flexibly to facilitate learning with good results CT is flexible in many places, many forms with different content and forms of learning The CT process requires teachers, students to be proactive, organized and methodical to achieve the best results

1.2.3 The current situation of clinical teaching

CT plays an important role in medical training The method of education requires promoting students' activeness, self-awareness, initiative, and creativity Since the 1980s, innovations in teaching methods at medical universities have begun to be paid attention but moving slowly

In fact, the CT skills and practices is gradually being forgotten and

overlooked at some medical universities in the world CT methods also tend

to confuse CP teaching with theoretical teaching Students do not know the

CP skills Active teaching methods have not been widely disseminated The organization and support of lecturers to make the CP process become more proactive and effective has not been paid enough attention The trend of floating CT, wasting training time are very common and serious in many universities Many important goals are neglected There is an imbalance between theory and practice; less teaching organization, management, statutes, rules, working style; a little combination of teaching community medicine skills, communication skills, counseling, health education, how to solve community-related health problems The university-hospital combination is not adequate which effects the hospital’s benefits as well as the student's academic results Defects in CT not only occur in a few universities but also can be seen in most medical universities

1.2.4 Several active clinical teaching methods

Some active teaching methods are used in the world and in Vietnam Including 1) Small group teaching; 2) Problem Based Learning; 3) Teaching

by case studies; 4) Teaching by roleplay; 5) Teaching by the bedside; 6) Teaching with progression diagram or flowchart; 8) Teaching by checklist

1.2.5 Some solutions to improve the effectiveness of clinical teaching

There are many solutions to improve the efficiency of CT Depending

on the universities, the time to apply Some solutions are: 1) Giving students early access to CT environment; 2) Improving the quality of clinical lecturers; 3) Improving the quality of CT methods with patients; 4) Innovating clinical evaluation methods; 5) Enhancing the application of IT

in CT, and 6) Organizing students to self-study clinically

1.2.6 Some domestic and foreign studies on clinical teaching

Le Van Cuong's study in 2008 applied active clinical learning methods

on 145 medical students, of which 78 students in the 3rd-year and 67 students in the 6th year were divided into 15 groups

Research by Tran Thi Thanh Huong, Le Thu Hoa et al in 2002 on 143 teachers and 1360 students of Hanoi Medical University on CT methods Research of Vu Dinh Chinh, Tran Thi Minh Tam, Nguyen Thi Lien et

al in 2006 on CT method

Research by Truong Viet Truong, Nguyen Thi Quynh Hoa et al in

2015 on regular students of Thai Nguyen University of Medicine and Pharmacy

Pham Thi Hanh's study in 2018 on medical students from Hai Phong University of Medicine and Pharmacy on the status of CT and intervention through positive teaching methods

Research of Nguyen Thi Quynh Nga in 2017 at VMU on CT method The study of Mc Manus I C, Richards P, Winder B.C in 1998 on 4,000

students at Marry Medical University in London on study habits affects the amount of clinical knowledge

Research of Ghasemzadeh I et al in 2015 on students of Hormozgan University of Medical Sciences, Iran on the medical teaching method Research of Seki Masayasu et al in 2016 on the clinical learning model of students

Research of Guishu Zhong and Xia Xiong in 2010 on students of Lusho Medical University on some factors related to clinical learning Josephine L Dorsch et al in 2004 studed on 3rd-year medical students

on evidence-based CT

Research of Sarah Parrott, Llison Dobbie, Heidi Chumley in 2006 and Research of Wolpaw Terry in 2012 on positive teaching methods

1.3 Overview of the medical record and electronic medical record

1.3.1 The role of medical record

MR is medical and legal documents Each patient has only one MR per medical examination, and treatment at a health facility Internship students, researchers, practitioners in medical examination and treatment facilities may borrow on-site MR to read or copy in service of research or professional and technical work The role of MR: 1) Helping properly diagnose and treatment, disease monitoring, professional improvement; 2) Serving scientific research work; 3) Administrative and legal documents base

1.3.2 Basic functions of medical record

The MR has the following functions: 1) Helping to identify and store patient records; 2) Managing the patient's anthropometric data; 3) Managing patient-specific issues; 4) Managing the list of medicines for patients; 5) Managing patient's medical history 6) Managing notes and documents: creating, supplementing, editing, and verifying information; 7) Creating the patient clinical documents from external sources; 8) Providing appropriate patient care planning, guidance, and implementation; 9) Summarizing and recording specific patient instructions

1.3.3 The structure and content of infectious medical record

The IMR has a basic structure of internal MR including 11 contents: 1) Administration; 2) Reasons for hospitalization; 3) History; 4) Pre-history; 5) Physical examination; 6) Summary of MR and preliminary diagnosis; 7) Subclinical testing; 8) Diagnosis; 9) Treatment; 10) Prognosis; 11) Prevention, health education

1.3.4 The electronic medical record

The EMR is a digital version of the MR, which is recorded, displayed, and stored by electronic means, has the same legal basis, and functions as the paper

MR prescribed in Article 59 of the Law on Medical Examination and Treatment The content of the EMR shall include all information fields in the form of MR used in medical examination and treatment facilities The use of the

EMR is a new step in medicine leading to changes in healthcare and medical research

In this project, the EMR is a MR sample designed on the basis of the contents of an IMR based on the application of Moodle software and E-learning technology When using the EMR, medical students are assisted in MRMS to improve the effectiveness of internships, suitable in the era of IT, and the lack of lecturers

1.3.5 Some research works on the medical record–making skills and the electronic medical record

Specialized case studies of medical students are often limited and integrated with other clinical skills Assessments of clinical skills are expressed in evaluating communication skills, examination skills, reasoning skills in making clinical diagnosis decisions, and health education counseling skills

Pham Thi Hanh's study in 2018 at Hai Phong University of Medicine and Pharmacy through intervention with positive CT methods

Research by Nguyen Duc Linh, Nguyen Thi Thanh Quyen, Ho Thi Le

et al 2011 in Tay Nguyen University on CP skills

Nguyen The Hien’s study in 2016 at medical universities on the quality assurance status of general practitioner education

Research by Ivan Solarte, Karen D Könings in 2017 at San Ignacio Universitario Hospital - Colombia, EMR programs and policies for students Research by R Jacobs, M Kane in 2019 on medical students in the United States on the use of the EMR for students

Research by White, Jordan et al in 2017 on the method of using the EMR with medical students

1.4 Application of information technology (IT) in medical training

1.4.1 Current situation of information technology application in medical teaching

IT plays a role in the advancement of medicine today and motivates medical students to study, solve problems, and many other benefits In the clinical environment, the traditional method of disclosing inadequacies is not having enough time for clinical lecturers to interact with students An increase in the number of students learning leads to the lack of clinical lecturers, limiting the self-study spirit, limiting the skill level of students An opportunity set for medical education is to apply IT to achieve its goals in teaching and learning In

2017, the Prime Minister issued Decision 117/QD-TTg approving the Project

"Strengthening the application of IT in management and supporting learning and scientific research activities, contributing to improving the quality

teaching-of education and training in the 2016-2020 period, with orientations toward 2025” However, medical universities in Vietnam have not yet effectively applied IT to education, especially in CT

1.4.2 E-learning teaching method

E-learning is a term used to describe learning and training based on information and communication technology, especially IT From a modern perspective, E-learning is the distribution of learning content, using modern electronic tools such as computers, satellite networks, Internet, Intranet Through a computer or television, teachers and learners can communicate with each other via the Internet in forms such as email, online discussion,forum, seminars, videos From 2000 to the present, E-learning has created a revolution in education and training E-learning has advantages: not limited by space and time; increased attractiveness; flexibility; updating; there are cooperation and coordination in learning; create pleasant psychology for teachers and learners E-learning has disadvantages that are: high technical cost; limited social communication skills; restricting experimental practices and requiring high personal awareness

The functional model of an E-learning system consists of 2 parts: Learning Content Management System and Learning Management System The system model consists of 3 main parts: 1) Communication infrastructure and network 2) Software infrastructure 3) Content of training

1.4.3 Moodle course management system

Moodle is an open-source online learning management system that allows creating courses on the Internet or online learning websites The characteristics of Moodle are: 1) Free and open source; 2) Educational philosophy; 3) Community Moodle has outstanding features compared to other CMS systems such as Blackboard, WebCT that help educators organize courses, effectively distribute learning materials, and introduce

innovative teaching methods

1.5 Clinical training program of infectious subject

The program and contents of infectious CP are conducted in the mornings for 4 weeks The learning contents include briefings; MRC; examination, diagnosis of diseases; treatment of diseases; lecturing, and studying in the patient chamber; join directly on schedule At the end of the

CP, the assessment was organized through grading the MR

Figure 1.1: Diagram research

CHAPTER 2 SUBJECTS AND METHODOLOGY

2.1 Research setting and research subjects

2.1.1 Research setting

At VMU and CP facilities for infectious subjects, including Faculty of Tropical Diseases - Nghe An General Friendship Hospital; Faculty of Tropical Diseases - Vinh City General Hospital; Faculty A4-Military Medical Hospital 4

2.1.2 Research subject

- Medical Student (5th year);

- Organic and visiting clinical lecturers;

- Leaders, managers, lecturers' representatives

2.2 Duration of Research

- From October 2017 to March 2018: Researching the current stituation

of infectious CT for medical students of VMU

Stage 3:

Evaluating the effectiveness of the EMR on subjects

Stage 2: Developing an E-Learning course to guide the infectious

MR-making and designing of the EMR sample Stage 1: Studying the current stuation of infectious CT

To assess the effectiveness of the EMR through comparing 2 groups after intervention

To assess the MRMS of the group using EMR for the first time at the end of week 1

To assess the

MRMS of the group

without using EMR

for the first time at

the end of week 1

To assess the MRMS of the group

without using EMR for the second

time at the end of week 4

To assess the MRMS of the group using EMR for the second time at the end of week 4

- From April 2018 to October 2018: Designing and completing the EMR on Moodle software, building an E-learning course

- From November 2018 to April 2019: Interventions on medical students using the EMR through the E-Learning course on guidelines for making the IMR

2.3 Research methodology and contents

2.3.1 Research design

2.3.1.1 Research design for Objective 1

Cross-sectional descriptive research design, quantitative research

2.3.1.2 Research design for Objective 2

The controlled intervention research design was used, combining quantitative research with qualitative research

- Quantitative research: comparing the results of the intervention group before and after with the control group to evaluate the effectiveness of the EMR intervention

- Qualitative research: focus group discussions and acceptance of the EMR from university leaders, managers, and lecturers

2.3.2 Sample size and sample selection

2.3.2.1 Sample size and sample selection for objective 1

- Calculating sample size:

+ Sample size of student group: All medical students of 2013 – 2019 course: a total of 367 students

+ Sample size of lecturer group: All clinical lecturers of the Department

of Infectious Medicine (including visiting lecturers): a total of 27 lecturers

- Method of sampling: All research subjects, including lecturers and students, were sampled to ensure the selection criteria: healthy and not disciplined; have good research cooperation attitude; voluntary participation

2.3.2.2 Sample size and sample selection for objective 2

- Calculating sample size:

+ Sample size for intervention research: the research subjects are general medical students in the 2014-2020 course Using the formula for calculating the sample size of the controlled trial, comparing the 2 rates of the IMR in the qualified level of 2 groups after being intervened with the EMR:

In which:

- n: the minimum sample size for intervention

- P1: expected rate of the intervention group to make a qualified IMR,

taking p2 = 85%

- P2: expected rate of the intervention group to make a qualified IMR

after intervention by the EMR, taking p2 = 85%

- P average = (p1 + p2) / 2 The average P was 77.5%

- Z (1-α / 2) = 1.96 (corresponding to the desired significance level, α =

0.05)

- Z (1-β) = 0.842 (corresponding to the strength β = 85%)

Thus, it was calculated by 138 Preventing the research subjects not participating, we provided an additional 10% and the sample size was 152 students for each group

+ Sample size for group discussions: Including university leaders,

managers, lecturers: about 10 people

- Selection of the research sample:

+ There were 308 medical students in the 2014-2020 course selected for research All students have the same characteristics, evenly distributed in

4 classes: Y14A, Y14B, Y14C, Y14D Based on the schedule of infectious

CP provided by the Training Department and to ensure the objectivity in evaluating the IE of EMR, we divided into 2 groups (the intervention and the control) based on the time of CP at the facility The CP schedule of the classes was completely random provided by the Training Department from the beginning (August 2018) The list of students in the class was arranged according to the regulations upon admission (2014) With this division, the control group would be contactless and known the EMR The intervention group would be followed by the EMR Students were assured of the following standards: 1) Healthy, not disciplined; 2) Having good research cooperation attitude; 3) Voluntary participation Specifically:

* Control group: Y14A and Y14D with a total of 156 students during the

CP period from November 19, 2018, to January 14, 2019

* Intervention group: Y14B, Y14C with a total of 152 students during CP period from January 15, 2019, to March 31, 2019

Figure 2.1: Diagram of CP process of two research groups

+ Intentional sampling for group discussion: university leaders (2 people), managers of the training department (3 people), clinical lecturers (5 people - 2 faculty members, and 3 visiting lecturers) A total of 10 people

2.3.3 Research contents

2.3.3.1 Research contents for objective 1

- The actual situation and opinions of CT staff:

+ The actual situation of CT lecturer staff (quantity, age, professional level, educational level, working seniority, seniority in CT, training in medicine pedagogy, and CT confidence);

+ Lecturer's opinion about contents of CT plans; CT methods; Contents

The CP group not used the EMR throughout the course

Control group Intervention group

The CP group used the

EMR throughout the

course

Students started the infectious

CP at the facilities

of the CT organization; Contents of CP assessment and student MR-making; Forms of evaluating CP results; Lecturers' needs for some topics related to CT; Needs to apply IT and the EMR in CT

- The current situation of CP and students' opinions on CT:

+ General information about students (gender, religion, ethnicity, CP facility);

+ Students' opinions on CT: Satisfaction level of students on conditions of CP facilities; contents of the training program; CT forms of lecturers; advantages and difficulties when CP; some contents in management, CT skills, organization, evaluation of CP results; the situation

of learning via MRs; students' needs for some topics related to CT; IT application needs in CP; knowledge of The EMR and needs of use and testing of The EMR

- Collecting available data: human resources, types of equipment of CP facilities, and the content of training programs for CT

2.3.3.2 Research contents for objective 2

- Comparing the average score of MRMS before and after the intervention and compared with the control group; calculating the effectiveness index, IE; the relevance of CP results with the 11 contents of the MR results

- Students self-assess about the adequate level of MRMS after intervention

- Students' feedback on about the E-learning course includes the objectives and content; the organization and management; the training method; the assessment methods; the facilities; the effectiveness; the most satisfying thing; the least satisfying thing; the advantages of applying IT in CT; replicating the course model

- Opinions and acceptance of university leaders, managers, and lecturers on the EMR include the urgency, significance; form; structure; accuracy, science, standard of medical terminology, and updating of the EMR; suitability with medical students; conditions for application the EMR

2.4 Steps to conduct research

2.4.1 Stage 1: Researching the current stuation of infectious clinical teaching for medical students

The study focused on describing the reality of the CT of infectious

subjects This phase carried out 3 contents: 1) Assess the current situation of

CT activities of the staff; 2) Assess the status of students' CP; 3) Collecting available data on the clinical training program of infectious subjects and human resources, equiments of CP facilities

2.4.2 Stage 2: Developing an E-learning course to guide medical making and designing of the electronic medical record

record Develop the content for the Erecord Learning course to guide MRrecord making The course was based on the website "Online training system" under the project "Human resource development program" of the Ministry of Health The system is operated by Hanoi Medical University Fellows create

courses that include: 1) Developing an "E-learning course to guide making the IMR"; 2) Request a domain name and create a specific address online; 3) Create a homepage and content for the course

- Designing the EMR

+ Building content structure of the EMR: Based on the structure of IMR, graduate students design the content structure of The EMR to every detail in the sections and information related to the Clinical situations and suggestions for solutions Each situation would help students not to forget the information of patients, choose the appropriate solution

+ Designing the EMR on the E-learning course: The whole content of the EMR structure was designed and integrated into the lecture in the form

of activity Using the module "Questionaire" to design the EMR according

to 11 contents: 1) Administrative information; 2) Reasons for hospitalization; 3) History; 4) Pre-history; 5) Physical examination; 6) Summary of MR and preliminary diagnosis; 7) Proposal for subclinical testing; 8) Summary of MR and definite diagnosis; 9) Treatment; 10) Prognosis of disease; 11) Prevention, health education Each content has detailed questions that prompt students to explore and there are situations for students to choose The suggested situations can be in the following forms: fill in the text in the answer box (Assay Box), check multiple options (Checkboxes), enter the answer in text form (Text Box); Yes/No option (Yes/No); fill in the numerical form (Numeric); fill out the date (Date); choose a situation in many situations (Radio Buttons), choose by the rate (Rate - Scale 1 5) or select a case of a box type (Dropdown Box) After completing all contents of the EMR, the software would saved the student's selections Students would have a full copy of the patient information that could be printed on paper or stored in the device and proceeded to write a complete MR

- Apply testing to learn about content technical issues

- Correction of technical and content errors, aesthetic

2.4.3 Stage 3: Evaluating the efficiency of the electronic medical record

on research subjects through E-learning course using Moodle software

2.4.3.1 Dividing the intervention group and the control group

The research subjects were divided into 2 groups The CP activities of the two groups was conducted the following process:

- The control group was instructed to make the IMR in the usual way

in the first week of CP At the end of the first week, students had to make

and submit the IMR according to the unified form (pre-intervention) From

the second week, they continued the scheduled of CP (not using the EMR) Students had to make the IMR the second time according to the unified form

at the end of the 4th week (Post-intervention) Lecturers would assess both

of times of the MRMS and the results of the CP process would be graded for the second time

- The intervention group also was instructed to make the IMR in the usual way in the first week of CP At the end of the first week, students had

to make and submit the IMR according to the unified form intervention) From the second week, students were given the account and

(pre-the instructions on how to access (pre-the course to continue (pre-the application of the EMR in CP Students made the IMR according to the unified form at the

end of the 4th week (Post-intervention) Lecturers would assess MRMS and

the results of the CP process would be graded for the second time

2.4.3.2 Intervening by using the EMR

The intervention group was provided with an account, password to access the course They exploited the course content and used the EMR during CP process There were 6 activities that students had to participate in: forums, online discussions (chats), using the EMR, completing self-assessment form, filling in the form of course feedback, and summiting the IMR

2.4.3.3 Evaluating IE by using the EMR through the E-learning course

- Developing a "The sheet of evaluating MRMS" with scoring for the criteria uniformly

- Evaluating the EI of EMR based on 4 contents

2.5 The standard of evaluation

The evaluation of MRMS followed the unified form below

Table 2.1: The evaluation score for medical record-making skills

of evaluation

Maximum Score

Fairly good Score

1 Exploiting the administration

2 Exploiting the reasons for

hospitalization 5 scores ≥ 3.5 scores

3 Historic exploitation 15 scores ≥ 10.5 scores

4 Pe-historic exploitation 10 scores ≥ 7 scores

5 Physical examination 15 scores ≥ 10.5 scores

6 Summary of MR and preliminary

7 Proposal for subclinical testing 10 scores ≥ 7 scores

8 Reasoning, definite diagnosis 10 scores ≥ 7 scores

9 Treatment of disease 10 scores ≥ 7 scores

10 Prognosis of disease 5 scores ≥ 3.5 scores

11 Prevention, health education 5 scores ≥ 3.5 scores

Total = 100 scores ≥ 70 scores

Each content had many criteria Each criterion had the attached scores There was a total of 70 criteria with a total score of 100 and 3 levels of evaluation: 1) No exploitation description: 0% points; 2) incomplete descriptive exploitation: 50% points; 3) Enough description: 100% points The score of each content and the whole of IMR was converted into a 10-point scale and compared with the classification of the "Regulation on the regular training of universities and colleges according to the credits system” by