Abstract
BACKGROUND:
There is an increasing need for a comprehensive assessment method to assess the various essential skills of Health Information Technology (HIT) students. This study aims to design, implement, and evaluate a holistic assessment method for HIT students.
MATERIALS AND METHODS:
This study was carried out in three phases. During the design phase, the expected competencies for professional roles were identified through the brainstorming sessions. In the implementation phase, the appropriate assessment method [project-based, objective structured practical evaluation (OSPE), multiple choice questions (MCQs), and real environment observation] was considered for each competency. In the assessment phase, the opinions of the stakeholders regarding the four-stage assessment were evaluated.
RESULTS:
Thirteen competencies of HIT graduates and their assessment methods were identified in three main areas: health information management, IT, and research. Students’ competencies were then assessed in two consecutive years (2022 and 2023). In the second period, students’ scores increased in competencies assessed as project-based, OSPE, and observation in the real environment and decreased in MCQs. The students’ views on the new comprehensive assessment method were also investigated based on four criteria. The mean scores for satisfaction, usefulness, and motivation increased among the students of the second course, while the mean score for stressors decreased.
CONCLUSION:
Despite the amount of time and energy that has gone for this method, the cost-effectiveness of the method has been recognized by the process designers. By repeating this method over the next years, students’ adherence to this style will increase and, in addition to reducing stress, they will improve their performance.
Keywords: Competency-based education, health information exchange, information technology
Introduction
In the process of academic education, student evaluation is an important aspect. On the one hand, evaluation allows the learner to measure the effectiveness of his/her teaching. On the other hand, it allows the educator to assess the learning level of the students.[1] Evaluation serves as a tool for self-reflection, allowing students to assess the skills they have learned and to identify areas for improvement as they become qualified providers of professional health services.[2] Evaluation methods should aim to measure a student’s knowledge and skills, identifying both strengths and weaknesses to provide opportunities for improvement and professional development.[1] Compared to traditional evaluation methods, multimode evaluation is an important step in the evaluation of any training program.[3] It is important to avoid focusing solely on scores and points. In medical education, various evaluation methods have been developed and applied over the years, including oral tests, practical demonstrations, written tests, multiple-choice questions (MCQs), and objective structured clinical evaluation (OSCE). The current approach to evaluation in medical education reflects the trend toward standard, objective, and competency-based evaluation methods that focus on assessing students’ ability to perform specific tasks.[2]
Over the past 2 decades, the evaluation of students’ practical adequacy through the OSPE method has become increasingly popular. OSPE is a structured, objective practical test that can consistently and objectively assess learners’ performance and demonstrate the extent to which practical training goals have been achieved.[4] In this method, trainees perform assigned tasks at numerous predesigned stations, while evaluators assess the practical process simultaneously and objectively.[5] The stations’ number, names, schedule, guide, and rotation process are determined through the elite consensus process.[6] Proper implementation of this method, along with training efficient and skilled personnel and reducing occupational errors, will help achieve the goal of patient-centered care.[7] This test identifies the learning weaknesses of learners before graduation, providing an opportunity to address pre-employment individuals’ skills shortcomings.[6] It also helps educational planners identify areas that require greater accuracy and higher quality training, allowing them to plan for problem-solving. Overall, feedback from both students and educators regarding the effectiveness of this test in assessing basic skills has been positive.[8] Overall, feedback from both students and educators regarding the effectiveness of this test in assessing basic skills has been positive.[9,10] This method has been widely adopted across various disciplines and can aid in developing curricula for fields with multiple practical skills, such as health information technology.
The field of Health Information Technology (HIT) is an exciting and rapidly growing branch of medical science that aims to manage health data using cutting-edge hardware and software tools to efficiently process, store, retrieve, and share it.[11] Its ultimate goal is to enable the use of health information and knowledge to facilitate communication and decision-making, ultimately leading to better patient outcomes.[12] HIT students are required to acquire a diverse range of capabilities, including health information management, information technology, and research project management, all of which are essential for success in this dynamic and rewarding field.[13]
There is an increasing need for a comprehensive assessment method that can assess the various essential skills of HIT students. There is no evidence that a process for the comprehensive evaluation of A learners has been carried out in Iran’s educational centers. However, in some internal studies, the design, implementation, and evaluation of some evaluation methods in different disciplines and their effects on students’ abilities have been discussed. Therefore, considering the importance of comprehensive evaluation of students’ knowledge, skills, and weaknesses at the end of the academic period, this study aims to create, implement, and evaluate a holistic evaluation method for HIT students.
Material and Methods
Study design and setting
The design of this study was structured into three phases: design, implementation, and evaluation. An exploratory sequential approach was employed in these phases, where initially a qualitative approach was conducted, followed by a quantitative one using the data from the qualitative step. It is a cross-sectional and descriptive analytical study that was conducted in the paramedical faculty of Hormozgan University of Medical Sciences.
Study participants and sampling
In the qualitative step, participants included nine faculty members from the HIT department who were proficient in evaluating various educational courses for students. In the quantitative step, the selected sample included 15 HIT students in 2022 and 17 students of the same field in 2023 participated in this study. The inclusion criteria were students of HIT and the last semester and those who had given informed consent to participate in this study.
Data collection tool and technique
In the first phase, a researcher-made data collection form was used to extract existing evaluation limitations as well as competencies and skills in the expert panel.
In the second phase of the study, a separate checklist was used in each section for the three sections of Project-based Assessment, OSPE Assessment, and Real environment observation.
In the other part, students’ cognitive assessment data were collected by holding an electronic test including 60 MCQs at the end of the eighth semester.
The tool used in the third phase of the study (Assessment) included a questionnaire with ten closed-ended and two open-ended questions. The closed-ended questions were scored on a Likert scale (Yes, Partially, No), with a score of 2 assigned to ‘Yes’, 1 to ‘Partially’, and 0 to ‘No’. The study employed closed-ended questions to comprehensively assess satisfaction, usefulness, motivating aspects, and stress-inducing factors. Additionally, an open-ended question was used to gather personal perspectives. The results were analyzed using content analysis.
The opinions of the assessment organizers, who were faculty members, were also evaluated as they were stakeholders in the process of learning and implementation. The participants were asked to give written feedback on three primary motivating factors, the effect of the process on their performance, and their willingness to repeat the process.
The phases of the present study are shown in Figure 1.
Figure 1.
Study phases
Ethical consideration
The present study was approved by the Ethics Committee of Hormozgan University of Medical Sciences, Hormozgan, Iran. Ethical approval code: (IR.HUMS.REC.1403.022). After obtaining permission from the committee, the purpose of the study was explained to all the participants in the study. Then, a written informed consent was obtained from all individual participants included in the study. Also, all parts of research in this study were conducted in accordance with relevant guidelines and regulations.
Results
Thirteen qualifications required for graduates of HIT were determined based on consensus among academic staff members and experts, in line with the first objective of the study. The study also revealed that the current assessment method is inadequate or incomplete. Table 1 shows that only three competencies were evaluated properly, while the rest were not evaluated adequately. As a result, the type, time, and tool of evaluation were determined [as shown in Table 2].
Table 1.
Determining the expected abilities and the current evaluation status of HIT graduates
| Competency field | Competency | Agreement degree on Competencies |
Relevant and expected skills | Current evaluation status | Suitability of Current evaluation method | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Between faculty members | Between experts | |||||||||||
| Research | Designing and conducting a research project | 83.3 | 0.75 | Writing a research proposal Implementation of research proposal |
It is evaluated individually with the opinion of the supervisor | not suitable | ||||||
| Health Information Management | Outpatient, inpatient and emergency admission | 100 | 100 | - Obtaining demographic information from the patient - Matching the patient’s data with the related system such as civil registry, insurance organizations and so on. - Obtaining consent letters - Filing and numbering files - Determining the department and coordinating with the inpatient department |
It is evaluated by observation method in the environment | suitable | ||||||
| Manual and electronic storage of information | 100 | 100 | - Organization within medical records - Organization of medical archives - Scanning medical records |
It is evaluated by the method of observation in the environment Not evaluated |
suitable | |||||||
| Quantitative analyzes of medical records | 100 | 100 | Quantitative analysis of medical records | It is not evaluated in a coordinated and uniform way in all centers. | not suitable | |||||||
| Distribute information manually and electronically | 100 | 100 | - Responding to case requests by stakeholders (patients, insurance, judicial authorities, etc.) -Retrieving information for educational and research purposes.) |
Not evaluated | Not evaluated | |||||||
| Coding of diagnoses and injuries | 100 | 100 | -Reading medical records -Scenario writing -Coding of diseases -Coding of diagnostic and therapeutic procedures |
It is evaluated by observation method in the environment It is not evaluated in a coordinated and uniform way in all centers. |
Suitable not suitable |
|||||||
| Statistical data management and presentation of reports at different levels | 100 | 100 | -Collect daily statistics -Matching statistics from different sources Statistical analysis and index calculation - Preparation of various statistical reports according to the needs of users at different levels -Registration in different systems |
It is not evaluated in a coordinated and uniform way in all centers. | not suitable | |||||||
| Health Information Technology | Skill of working with HIS system and subsystems in hospitals | 100 | 100 | Patient admission, transfer and discharge, working with the health information management module, working with the service definition module and other HIS modules | Evaluation is done by observing in the environment, but often it was not possible to evaluate for all students | It was appropriate but not comprehensive | ||||||
| The skill of working with a simulated electronic patient record (Open EMR) | 100 | 87.5 | Define clinic, admit patient, define insurance, work with program settings and add ICD databases | Evaluation is done by observing in the environment, but often it was not possible to evaluate for all students | It was appropriate but not comprehensive | |||||||
| The skill of working with a simulated disease registry (DHIS2) | 100 | 87.5 | Creating a registry, defining access levels, creating data elements and information forms, creating reports | Evaluation is done by observing in the environment, but often it was not possible to evaluate for all students | It was appropriate but not comprehensive | |||||||
| Skill in database management (SQL) | 100 | 0.75 | Creating a database and running basic queries in W3School, taking backups and restores | Evaluation is done by observing in the environment, but often it was not possible to evaluate for all students | It was appropriate but not comprehensive | |||||||
| The skill of making reports using report-making software (Crystal Report) | 100 | 0.75 | Creating and editing HIS reports in Crystal Report software | Evaluation is done by observing in the environment, but often it was not possible to evaluate for all students | It was appropriate but not comprehensive | |||||||
| Computer and computer network maintenance skills | 100 | 87.5 | Assembling a computer, fixing system problems such as RAM, graphics, hard drive, etc., making patch cord cables, fixing network hardware and software problems | Evaluation is done by observing in the environment, but often it was not possible to evaluate for all students | It was appropriate but not comprehensive | |||||||
Table 2.
Determining the type of evaluation proposed based on each of the necessary capabilities for graduates of the field of HIT
| Competency fieldw | Approved evaluation type | Evaluation time | Evaluation tool | |||||
|---|---|---|---|---|---|---|---|---|
| Research | Designing and conducting a research project | project-based | During 7th and 8th semester | checklist | ||||
| Health Information Management | Outpatient, inpatient and emergency admission | observation in the environment | During the internship | checklist | ||||
| Manual and electronic storage of information | observation in the environment | During the internship | checklist | |||||
| Quantitative analyses of medical records | observation in the environment | During the internship | checklist | |||||
| Distribute information manually and electronically | observation in the environment | During the internship | checklist | |||||
| Coding of diagnoses and injuries | OSPE& MCQs | End of internship | checklist | |||||
| Statistical data management and presentation of reports at different levels | observation in the environment and MCQs | During the internship | checklist | |||||
| Health Information Technology | Skill of working with HIS system and subsystems in hospitals | OSPE | End of internship | checklist | ||||
| The skill of working with a simulated electronic patient record (Open EMR) | OSPE | End of internship | checklist | |||||
| The skill of working with a simulated disease registry (DHIS2) | OSPE | End of internship | checklist | |||||
| Skill in database management (SQL) | observation in the environment | During the internship | checklist | |||||
| The skill of making reports using report-making software (Crystal Report) | OSPE | End of internship | checklist | |||||
| Computer and computer network maintenance skills | MCQs | End of internship | MCQ | |||||
Three assessment methods (observation in the environment, OSPE, and CMCQs) were used to evaluate qualifications in information technology and health information management.
To achieve the second goal of the study, which is implementation, the researcher conducted a study on 15 HIT students in 2022 and 17 HIT students in 2023. The results of the tests taken from the students in both periods are presented in Table 3. The table indicates that the average test scores in the second term were higher than those in the first term. However, the average scores of the MCQ exam in the second period were lower.
Table 3.
Comparison of the mean scores of students in two test periods
| Assessment type | First course (2022) | Second course (2023) | ||
|---|---|---|---|---|
| Project-based | 17.6 | 18.16 | ||
| OSPE | 16.77 | 17.88 | ||
| MCQs | 15.25 | 14 | ||
| Real environment observation | 18.5 | 18.80 |
Following the realization of the third objective of the study, the viewpoints of learners about the new comprehensive assessment method were examined based on four criteria [Table 4].
Table 4.
Comparison of learners’ surveys in two test periods
| Survey of learners | The average of first periods | The average of second periods | ||
|---|---|---|---|---|
| Satisfactory | 1.45 | 1.63 | ||
| Usefulness | 1.53 | 1.77 | ||
| Motivating | 1.29 | 1.63 | ||
| Stressful | 1.26 | 0.88 |
The mean score for satisfaction, usefulness, and motivation has increased among second course students, while the mean score for stressors has decreased. This decrease can be attributed to the issues faced during the first test period, such as incoherent planning, delayed notifications, and lack of resource announcements.
Qualitative findings from students’ attitudes showed a positive reception of this evaluation method. First, they appreciated the evaluation method’s comprehensiveness. Second, they valued the specialized design of the evaluation methods tailored to their field. Third, they found the content aligned with the capabilities defined for graduates. Finally, the evaluation time for each field was proportional to its nature.
The faculty members’ personal attitudes toward the evaluation method were positive. First, the evaluation process was purposeful as it considered the main criteria for an undergraduate HIT graduate. Second, the evaluation process was comprehensive, diverse, and tailored to the purpose of each specialized field, allowing for an in-depth understanding of the learners’ knowledge. Finally, it identified strengths and weaknesses in each student’s specialized areas of education.
Discussion
This study presents a comprehensive evaluation method for HIT students, including the determination of required qualifications for HIT graduates and an assessment method for evaluating these qualifications. The study’s most significant aspect was conducting OSPE.
The results indicate that students’ mean scores in the second course improved compared to the first. First-year students experienced higher levels of stress and lower performance due to their lack of prior experience.[14] The novelty of this method presents limitations, including student stress and the inability to measure all necessary skills. Several studies have highlighted the stress and anxiety caused by OSPE.[15,16] By including this method in future courses and incorporating it into the formal educational program of HIT, the impact of OSPE uncertainty on students’ performance can be reduced. Research suggests that effective stress management programs for students can improve scores on structured tests.[17,18] The study results indicate that students were highly satisfied with the test method and found it to be useful and motivating. The mean satisfaction score was higher in the second entrance compared to the first. Previous studies have also reported high satisfaction rates among students.[19] The test’s motivational aspect may contribute to its success.[14] The OSPE test objectively and practically assesses students’ skills during a scenario. The assessment environment is standardized for all assessors and evaluates communication skills in addition to scientific skills. Therefore, OSPE determines a student’s skill level and the ability to apply those skills in a real-world environment. Identifying weaknesses in the training process allows for their resolution.[6]
The qualitative findings of the study showed that, from the students’ point of view, all the necessary HIT skills were comprehensively covered. There was a sufficient amount of time allocated for the implementation of each skill. In other studies, participants felt that this type of assessment covered all the required skills. The design of the stations, the timing, and the rotation of the learners between the stations are crucial to ensure accuracy and to give the learners sufficient time to complete the desired tasks.[20] Traditional assessment methods tend to prioritize rote learning, which may hinder the development of the necessary skills in graduates.[21]
According to HIT professors, this test serves the purpose of determining students’ strengths and weaknesses. The interdisciplinary nature of HIT can enhance access to healthcare services and their quality. Therefore, it is crucial to accurately assess the skills of HIT graduates.[22] As employees in this field require a wide range of competencies,[23] all skills should be considered during assessments. The study’s results indicate that appropriate station design has enabled the evaluation of all these skills. The test results offer teachers an opportunity to review the curriculum and identify areas that require better education.[24] The gap between theory and practice arises from the lack of coordination between academic learning and its real-world application. Therefore, educational programs should provide a foundation for the scientific and practical advancement of graduates.[25] The use of OSPE can evaluate all three areas of learning: emotional, cognitive, and psychomotor.[6] Consistency in this method can lead to a long-term change in education, relying on tangible changes in vision and performance rather than focusing on learned knowledge.
Like other studies, this study had limitations. The first limitation of this study is the lack of comparison of the OSPE test scores with the mean of the practical, theoretical, and work placement courses. Such a comparison can illustrate the difference between traditional and OSPE assessments. In addition, student grades were not evaluated by station. Due to the wide scope of the HIT, several stations were designed. Comparing the scores of each student and the overall mean of the students can help to better identify the strengths and weaknesses of the HIT curriculum. Meanwhile, studying the correlation between station scores also helps to better understand the relationship between the different skills in the field.
Conclusion
The comprehensive assessment method has identified the required competencies of HIT graduates. By repeating this test in the coming years, students’ adherence to this style will increase and, in addition to reducing stress, they will improve their performance. The increasing prevalence of information technology in the health care system has brought about a great need for HIT specialists. Any effort to upgrade the skills of these experts will bring significant benefits to all stakeholders. Decision makers and health policy makers can use the results of this test to develop suitable educational strategies for training such specialists. Although a lot of time and energy is spent on designing and implementing such an evaluation method, its benefits will more than make up for these costs. The current challenges and problems of this test will also be solved by continuously receiving feedback from the learners and making the necessary corrections.
Conflicts of interest
There are no conflicts of interest.
Acknowledgements
The researchers thank and appreciate the respected directorate, the honorable Deputy of Education, the respected personnel of the Education Development Center of the School of Paramedical Sciences and the head of the University Education Development Center as well as the staff of the Department of Statistics and Technology of the University who helped them in the advancement of this process.
Funding Statement
This project was approved and funded by Hormozgan University of Medical Sciences. (No. 4020451).
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