Medical students’ awareness and perception of national health examinations

Key ingredients for upgrading health care include bolstering and appraising professional medical education. Health examination as a crucial element of health care that we must incorporate into medical education. This research evaluates medical students’ awareness of national health examinations. Two surveys, focused on health examination knowledge and perspective, were conducted for first- to fourthyear medical students, results analyzed by descriptive statistics, t-test and ANOVA. Research subjects scored maximum 11 (of possible 15): i.e., 76.2% accuracy for health examination knowledge questions and held positive views on seven (58%) perspective-related questions. Self-directed learning courses do provide a positive effect on students’ learning. Respondents’ varying backgrounds had insignificant impact on overall results, but in-depth analysis for each individual question does reveal differences among several backgrounds. Medical students’ overall awareness level for health examination is above average in comparison to the general public. This research result can provide a basis to improve the related professional programs, courses and teachings or used as a reference for modifications on future classes. The above observations were discussed based on the medical education system in Taiwan.


Introduction
New challenges arise everyday in a fast-changing society, with medical departments and agencies worldwide forced to adapt via new and immediate solutions. In recent years, apart from stress on professional skills in medical education reforms, there is increased focus on humanity as a mission for social health care [1,2]. Taiwanese medical education has thus agreed on doctors' professional development as vital to relevant medical reforms: (1) integrating fundamental and clinical courses, (2) nurture of students' self-directed learning, (3) team learning, (4) health treatment for humanity, (5) enhancing clinical skills and early clinical exposure, (6) facing fundamental and community health care [3]. Medical education has gradually shifted its focus to integrating with practical application and connecting seamlessly with medical education in advanced nations, making it pivotal to integrate fundamental and clinical courses while reconstructing content of medical education in a holistic way.
Since emphasis on citizens' health is clearly defined, medical departments worldwide have evolved comprehensive care systems for their citizens [4,5]. Taiwan, with its people steadily accumulating economic means and their lives ever more stable, has begun to realize the importance of performing regular health examinations. Due to widespread use of computers and rapid growth of Internet, citizens' knowledge of health care resources likewise escalates [6]. This raises the importance of analyzing and interpreting health exam results; further problems emerge if citizens lack accurate understanding thereof. Hence, appropriate knowledge, such as interpretation, further medical counseling, etc., must be given to health examination subjects to assist them to view health care and medicine from a prevention standpoint. Holistic care forms a concept for viewing individual as the core basis, family as center and community as parameter to provide medical care and prevention health care services [7].
The practical application of the holistic health care can only be achieved with a quality holistic medical education program Medical students' awareness and perception of national health examinations [8]. Hence all medical schools should practice holistic medical education, implement diverse program design, hoping this will allow future medical students to become well qualified doctors [9]. Initial experimental design is survey with items related to

Methods
Through literature review, this research identified key factors in health examination, survey instrument designed in accordance with these key components. Expert reviews and pre-test were conducted before actual experiment. The following sections will elaborate on research samples, tools, and data processing.

Research subjects
Population used in this research consists of students from a medical college located in central Taiwan

Data analysis
After collecting all survey results, ineffective surveys were removed, statistical methods determined by characteristics of the data as well as items warranting analysis by statistical software, SPSS 18.0 for Windows. Methods such as descriptive analysis, t-test, one-way ANOVA etc. evaluated resulting data.

Health examination knowledge and perspective
Survey items were modeled after health examination checklist items promoted by Taiwan's Ministry of Health and Welfare.
Format used yes or no answers for each question, correct answer yielding one point and incorrect answer zero: i.e., maximum score of 15 points, with total average points utilized for analysis.
Higher score meant greater awareness (    In the self-evaluation s ection, skill level t o read b lood s ample data and determine ECG normality is quite low, as portended by Questions 9 (24.9%) and 10 (14.9%)

Effect of gender and hospital volunteer experiences on awareness level towards health examinations
Using gender and hospital volunteer experiences as independent and survey answers as dependent variables, independent sample t-test gauges health examination knowledge and perspective as a result of students' background. Results indicate no significant difference in total and individual score for each question.

Medical students' awareness level toward health examination reflected by different backgrounds
Using grade level of students, parents' educational level and/or occupation, plus number of health examinations within the last five years as independent and survey answers as dependent variables for one-way ANOVA, overall results indicated that differences in background had no direct correlation with scoring in knowledge and perspective. Analysis of each question reveals differences relating to backgrounds.

Medical students of different grade levels
Four items scored substantial differences between grade levels, using Scheffé comparison, substantial differences noted for three.
On Question 10, juniors outscored freshmen. On perspective Question 9 relating to reading blood sample data, agreement level for seniors was substantially higher than for sophomores.
On perspective Question 12, freshmen also showed a higher agreement level than seniors (Table 3).

Discussion
Medical students' understanding and caring for the health care system constitutes a critical topic for medical education reform.
Health examination is one fundamental concept for health care: letting citizens grasp the importance of health examinations as one key policy promoted by the national government [5]. While many articles relate to physical health assessment [10][11][12] Evidence-based medicine has been proven that many diseases    [16]. Such an idea was noted by Dewey, American educationalist, in the 1960s: "learn by doing," integrates service and classroom courses to transform society's resources as pedagogical material [17]. It mainly uses health-related themes in activities for subjects ranging from grade school students to community elders. Respondents have experiences in this realm, and these are required freshman courses. Differential analysis for this question reflects that freshmen who have taken this class have higher self-recognition than students in other grades. Items answered wrongly include Question 1, addressing professional medical courses, among which is common latent cancers, a task entailing professional examination assistance [18]. Question 6 relates to medical responsibility: examination items performed by professionals. Question 10 is on clinical practice, ability to read ECG, perhaps because this task requires more experience; students generally feel diffident here. Question 12 assesses categories offered in health examination that encompass more than three categories; substantial discrepancy arises in its differential analysis. Comparison afterwards reflects freshmen recognizing more such categories than seniors; reasons merit exploration. Sections linked to health examinations with more misconceptions include fundamentals and clinical practice; this lends reference for design of material.

Conclusion
This study concludes that medical students possess fundamental knowledge towards health examination policies promoted by Taiwan's Ministry of Health and Welfare albeit only an average health examination-related perspective; overall awareness of knowledge and perspective on health examination is deemed above average. Self-conducted courses such as problem-based learning (PBL) and service learning will imbue a much stronger impression on related topics. Some differences exist in medical students of varying backgrounds, worth future research to gain further understanding. The above results can enhance related professional courses and teachings, as well as reconstruct programs' content quality in future medical education reform discussions to view reflect societal needs. Most effort now must focus on incorporating awareness of national examination policies within medical fundamental profession and clinical practice to build holistic healthcare learning environment that renders well-qualified doctors to ensure national health.