Assessing medical statistical reasoning ability of students when solving practical problems - 2

Table 4.5. Lecture objectives corresponding to the levels of Medical Statistical Reasoning ... 112 Table 4.6. List of 14 problems with a medical clinical context 120

Table 4.7. Statistics of the number of targets corresponding to the level of Medical Statistical Inference 121

Table 4.8. Test matrix for assessing SLTKYH capacity Description (Matrix 1) 124

Table 4.9. Test matrix for assessing SLTKYH capacity (Matrix 2) 125

Table 4.10. Description of the test question set of Test 1 126

Table 4.11. Structure of the test questions of Test 2 127

Table 4.12. Description of the question set of Test 2 128

Table 4.13. Corresponding scale of Medical Statistical Reasoning level of matrix 1 .. 129 Table 4.14. Corresponding scale of Medical Statistical Reasoning level of matrix 2 .. 130 Table 4.15. Corresponding answer results for each objective multiple choice question 131

Table 4.16. Corresponding answer results for Question 7 of Test 2 132

Table 5.1. Percentage (%) of students achieving Medical Statistical Reasoning levels for Test 2 139

Table 5.2. Answers corresponding to question 7 of Test 2 141

Table 5.3. Answers corresponding to question 16 of Test 2 145

Table 5.4. Percentage (%) of students achieving Medical Statistical Reasoning levels for Test 1 145

Table 5.5. Percentage (%) of students answering correctly the questions on the reproduction level, reflected in Test 1 147

Table 5.6. Results of answers corresponding to question 1 of Test 1 149

Table 5.7. Answers corresponding to question 14 of Test 1 151

Table 5.8. Answers corresponding to question 15 of Test 1 153

Table 5.9. Test matrix for assessing SLTKYH capacity (Matrix 3) 162

Table 5.10. Description of the question set of Test 3 162

Table 5.11. Percentage (%) of students achieving Medical Statistical Reasoning levels for Test 3 163

Table 5.12. Corresponding answer results for question 4 of Test 3 167

Table 5.13. Answers corresponding to question 5 of Test 3 168

Table 5.14. Answers corresponding to question 15 of Test 3 171

PICTURE

LIST OF DRAWINGS, DIAGRAMS

Page

Figure 2.1. Three relatively independent defined regions with some interference 18

Figure 2.2. SLTK and TDTK contained in HBTK 19

Figure 2.3. Basic changes in the two versions of Bloom's taxonomy 36

Figure 2.4. Bloom's Taxonomy for Medical Statistical Reasoning 43

Figure 3.1. Questions in the XS-TKYH subject exam for the 2015-2016 school year 78

Figure 3.2. Distribution of Math exam scores of medical students in 2015 81

Figure 3.3. Distribution of Math exam scores of medical students in 2016 82

Figure 3.4. Distribution of Math exam scores of medical students in 2017 82

Figure 4.1. OECD/PISA (2009) Mathematization Process 101

Figure 4.2. Model for assessing SLTKYH capacity when solving real-life problems 102

Figure 5.1. Score distribution of Test 2 139

Figure 5.2. Student's answer to question 7 of Test 2 142

Figure 5.3. Distribution of the percentage of students achieving the SLTKYH levels for Test 1 146

Figure 5.4. Student 1's answer to question 1 of Test 1 151

Figure 5.5. Student 2's answer to question 1 of Test 1 151

Figure 5.6. Student 3's answer to question 1 of Test 1 152

Figure 5.7. Student 4's answer to task 1 of Test_thuchanh 159

Figure 5.8. Student 4's answer to task 2 of Test_thuchanh 160

Figure 5.9. Distribution of the percentage of students achieving the SLTKYH levels for Test 3 164

Figure 5.10. Student 5's answer to question 4 of Test 3 167

Figure 5.11. Student 6's answer to question 5 of Test 3 169

Figure 5.12. Student 7's answer to question 5 of Test 3 169

DIAGRAM

Figure 3.1. Types of medical research designs 54

CHAPTER 1

PROBLEM INTRODUCTION

1.1. Reasons for choosing the topic

Statistics is the science of collecting, analyzing, interpreting, and presenting data to find out the nature and regularities of natural and economic phenomena.

- society. Statistical science is based on statistical theory, in which the model of randomness and uncertainty is built on probability theory. According to Moore (1998) "Statistics is a general cognitive method that is applied wherever data, variation and chance appear. It is a fundamental method because data, variation and chance are everywhere in modern life. It is an independent discipline, with its own core ideas, rather than a branch of mathematics" .

Medical statistics (MST) is the science of statistics applied to the field of medicine, including medical research, clinical medicine and research on public health care (Tran Thi Dieu Trang, Tran Thuy Hien, 2015). Statistics have many important applications in diagnosis, treatment and especially scientific research in medicine. Medicine requires a sophisticated understanding of statistical evidence to understand, interpret and evaluate clinical trials, and probabilities to compare risks. A doctor when faced with a new discovery in medicine or a pharmacist when analyzing experiments needs to have basic statistical reasoning and thinking to guide their explanations. According to Ben-Zvi & Garfield (2004) described " Statistical reasoning is reasoning with statistical ideas and making statistical information meaningful ". In the treatment of cerebral infarction, for doctors, studying biological markers will be very helpful in early diagnosis, predicting the severity and risk of death for patients with cerebral infarction, especially when there is no brain damage on CT scan (Hoang Trong Hanh, 2015). Surveying the concentration of S100B protein and NSE serum of patients, from the collected results of the data sample, to consider whether these are useful markers in the diagnosis and treatment of cerebral infarction or not, it is necessary to perform Statistical Inference (SLTK).

1.1.1. The role of Medical Statistical Inference

In the training program of medical and pharmaceutical majors, statistical theory and probability are compulsory subjects for students in the first years of university. Starting from the 2013-2014 school year, the training program for health sciences majors has changed, there is no Advanced Mathematics subject, the Probability-Statistics subject is changed to Probability-Medical Statistics (XS-TKYH), in which the objectives and content of the subject also change to be more suitable for the characteristics of medical and pharmaceutical students and in the condition of having the support of SPSS statistical software, which is accessed in the Applied Informatics section.

In the era of information explosion, along with the strong development of information technology applications, teaching statistics should enhance students' awareness of data in daily life, prepare them with professional skills and the role of statistical reasoning becomes more and more important. Students also need to have a good understanding of the basic ideas of statistics to be able to summarize the information that is flooding their daily lives, need to think critically and make decisions based on that information. When it comes to Medical Statistical Inference (SLTKYH) or statistical reasoning in medicine, Moyé (2006) described "The essence of SLTKYH is the process of determining whether research results based on a sample can be extended, generalized to the whole or not" . SLTKYH focuses on the fundamentals of statistical thinking in medicine to decide when and how we can draw results from a sample and apply them to a population in the field of healthcare research.

In universities in general, and in medical universities in particular, one of the teaching goals that needs to be aimed at is to develop scientific research skills for students. That means teaching statistics must ensure the promotion of the application of the scientific method for most students, including abilities such as asking questions, selecting data, exploring and applying tools to interpret data, and the ability to communicate and exchange results . Statistics is linked to all aspects of the scientific method. To achieve these goals, according to Ben-Zvi & Garfield (2004), students need to understand and use the basic ideas of statistics at many different levels: First, there must be some level of competence, such as the ability to understand

basic ideas, terms, symbols and language of statistics, called statistical literacy (HBTK). Then, to become a “statistical citizen” and a “scientific researcher”, it is necessary to have more advanced levels of competence, such as the ability to explain, decide, reason, evaluate and make a decision about information . These skills are necessary for the process of SLTK and statistical thinking (TDTK).

1.1.2. Assessment – ​​an important element of the teaching and learning process

In education, assessment is carried out at different levels, on different subjects and for different purposes. In the teaching and learning process in general, and in university teaching and learning in particular, student assessment is the direct task of lecturers. Students are both the object and the product, and at the same time the subject of the teaching and learning process. Therefore, student assessment has a particularly important position in the assessment of university education.

Evaluation is considered an inseparable part of the teaching and learning process but still has a certain independence from this process. Evaluation must be based on specific goals, programs and standards, not depending on the subjectivity of the teacher. Therefore, evaluation has an impact on adjusting and orienting the teaching and learning process. Evaluation with both qualitative and quantitative descriptions of student behavior along with more valuable comments related to the level of that behavior. Use the collected information to make decisions about further teaching, about the program, about activities. Decisions about evaluation results; decisions about the value of program results may involve recommendations for changes.

Assessment is considered an important factor in the teaching and learning process, not only for the purpose of scoring and classifying students, but more importantly, assessment is a good support tool in improving the quality and effectiveness of teaching and learning. Talking about the role of assessment in education, according to Lewy (1990), "Assessment, in many forms, can have a positive impact on the teaching and learning process". Assessment processes include assessment of knowledge, assessment of understanding, competencies and skills. Assessment helps promote learning by providing feedback. Useful assessments will help teachers adjust their teaching and provide students with more opportunities to demonstrate success in the learning process. For teachers, developing useful assessments can improve teaching and help students in the learning process.

1.1.3. Needs and trends of innovation in teaching Medical Statistics

Although there is an increase in demand for teaching statistical analysis, through the practice of teaching this subject to medical students for many years, we have found that for many students this is still a difficult and uninteresting subject. For teachers in the process of finding an effective teaching method, they have encountered a number of challenges. According to the traditional approach, teaching mainly revolves around basic knowledge, most of us focus on techniques, procedures, statistical calculation processes, without paying attention to statistical analysis; this has made statistics seem like a subject that mainly involves memorizing formulas, applying procedures, performing calculations and therefore seems to be less useful for students in life as well as in professional practice , especially with the strong development of applied statistical software as it is today. Reality also shows that assessment is used in teaching mainly for the purpose of scoring, classifying, and providing periodic feedback on students' learning. With such a purpose, assessment cannot promote its important role and position in teaching and learning. The exercises in the final exam of the TKYH course of students in the form of essays are simply at the level of reproducing, recalling, and demonstrating the ability of students to perform calculations and apply procedures accurately, and do not really reflect well the way students think, reason, and apply their knowledge.

Therefore, in our opinion, there is an urgent need for real reform and innovation in teaching and learning methods, as well as assessment methods in teaching and learning statistical analysis. Teaching and learning methods of statistical analysis for medical students need to be innovated in the direction of making students see the applications and be able to apply statistical knowledge to solve practical medical problems. Following the new trend in statistics education, researchers suggest that teaching statistics in general should focus on developing statistical analysis skills rather than calculation procedures and processes. Gal (2002) suggests that "statistics should be considered an overarching goal in teaching statistics". Thus, the goal of teaching statistical analysis needs to focus on developing statistical analysis skills for students. Especially, in an era where people increasingly use modern scientific and technological means, the ability to reason, think and solve problems (SP) becomes more urgent than before.