2.1 Study design and process
This study aimed to create an ‘Ideological and Political Teaching Evaluation Index System for Medical Courses’ to evaluate the effect of ideological and political education in medical courses. The evaluation objects were mainly teachers and students, and the contents of the evaluation index system were preliminarily determined using a policy and literature review. The Delphi method and recruited experts in medical education were used to revise and assess the initially established curriculum evaluation index system and form the ‘Evaluation Index System of Ideological and Political Teaching in Medical Courses’.
2.2 The source of the evaluation index system
The contents of the index system were mainly based on the Chinese government’s relevant policy requirements for ideological and political curriculum in medical training and literature on the core elements of the ideological and political construction of medical courses.
2.2.1 Government policy documents on the ideological and political curriculum in medical training
The Chinese government created various educational and teaching guidelines to strengthen the ideological and political construction of the curriculum for training medical students. Specific results are shown in Table 1 (1, 7-11) and Table 2 (2, 12, 13).
[Table 1 here]
Table 1. Documents related to curriculum ideology and politics
Serial number
|
Publishing time
|
Issuing department
|
File name
|
Related information
|
1
|
2017
|
Ministry of Education
|
Implementation Outline of the Quality Improvement Project of Ideological and Political Work in Colleges and Universities
|
Vigorously promote the reform of classroom teaching with the goal of course ideology and politics. It includes optimizing curriculum settings, revising professional teaching materials, improving teaching design, strengthening teaching management, identifying ideological and political education elements and functions in professional courses, and integrating them into all aspects of classroom teaching (Notice of the Party Group of the Ministry of Education of the Communist Party of China on Printing and Distributing the "Ideological and Political Work Quality Improvement Project Implementation Outline in Colleges and Universities", 2017).
|
2
|
2018
|
Ministry of Education, Ministry of Finance and National Development and Reform Commission
|
Guiding Opinions on Accelerating the Construction of Double First-Class in Colleges and Universities
|
Vigorously promote the reform of classroom teaching with the goal of ideological and political courses and curriculum to provide a unified direction for various courses, resources, strengths, and theory and form a synergistic effect (Notice of the Three Departments Printing and Distributing the “Guiding Opinions on Accelerating the Construction of ‘Double First-Class’ in Colleges and Universities”, 2018).
|
3
|
2018
|
Ministry of Education
|
Opinions on Accelerating the Construction of High-level Undergraduate Education and Comprehensively Improving Talent Cultivation Ability
|
Focus on promoting colleges and universities to comprehensively strengthen the ideological and political development of courses, achieve successful designs, and create the contents of ideological and political education scientifically and reasonably based on the characteristics of various professional personnel training and quality requirements of professional ability (Opinions of the Ministry of Education on Accelerating the Construction of High-level Undergraduate Education and Comprehensively Improving Talent Cultivation Ability 2018).
|
4
|
2019
|
General Office of the Central Committee of the Communist Party of China and Office of the State Council
|
Several opinions on deepening the reform and innovation of ideological and political theory courses in schools in the new era
|
Solve the problem of mutual cooperation between ideological and political courses and other courses, and fully utilize the educational function of all courses (The General Office of the Central Committee of the Communist Party of China and the General Office of the State Council issued "Several Opinions on Deepening the Reform and Innovation of Ideological and Political Theory Courses in Schools in the New Era", 2019).
|
5
|
2019
|
Ministry of Education
|
Opinions of the Ministry of Education on Deepening the Reform of Undergraduate Education and Teaching to Comprehensively Improve the Quality of Talent Training
|
Consider the ideological and political construction of courses as the key link in implementing the fundamental task of creating morality and cultivating people. Adhere to the unity of knowledge, imparting and value guidance, and the unity of explicit and recessive education. Fully explore the ideological and political education resources contained in various courses and teaching methods (Opinions of the Ministry of Education on Deepening the Reform of Undergraduate Education and Teaching to Comprehensively Improve the Quality of Talent Training, 2019).
|
6
|
2020
|
Ministry of Education
|
Guiding Outline for Ideological and Political Construction of Colleges and Universities
|
Scientifically design ideological and political teaching systems for courses, promote the ideological and political construction of courses combining the classification of professional characteristics, integrate the ideological and political courses into the whole process of classroom teaching design, and improve teachers’ awareness and ability to design courses based on ideological and political concepts (Notice of the Ministry of Education on Printing and Distributing the "Guidelines for the Ideological and Political Construction of Colleges and Universities", 2020).
|
[Table 2 here]
Table 2. Curriculum ideological and political requirements in documents related to medical personnel training
Serial number
|
Publishing time
|
Issuing department
|
File name
|
Main content
|
1
|
2017
|
Office of the State Council
|
Opinions on Deepening the Collaboration of Medical Education and Further Promoting the Reform and Development of Medical Education
|
Ideological and political education and the cultivation of medical ethics should be embedded in the whole process of education and teaching, promote the organic combination of humanistic and professional education, and guide medical students to take the prevention of diseases, relieving pain, and safeguarding the health rights and interests of the public as their professional responsibilities (Opinions of the General Office of the State Council on Deepening the Collaboration of Medical Education and Further Promoting the Reform and Development of Medical Education 2017).
|
2
|
2018
|
Ministry of Education, National Health Commission, State and Administration of Traditional Chinese Medicine
|
Opinions on Strengthening the Collaboration of Medicine and Education to Implement the Excellent Doctor Education and Training Program 2.0
|
Comprehensively strengthen the quality and ability training of moral and medical dual cultivation, utilize moral education as the primary content of medical personnel training, and integrate ideological and political aspects and professional quality throughout the entire process of education and teaching.
Further improve professional quality education with medical professional ethics, attitude, and values as the basic content (Xie et al. 2019).
|
3
|
2020
|
Office of the State Council
|
Guiding Opinions on Accelerating the Innovative Development of Medical Education
|
Improve the professional quality of medical student education, strengthen the education of medical ethics and scientific research integrity, utilize the ideological and political role of the curriculum, and concentrate on cultivating the spirit of saving the dying and helping the wounded among medical students (Guiding Opinions of the General Office of the State Council on Accelerating the Innovative Development of Medical Education 2020).
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The requirements of government policies on education and teaching reform and medical personnel training focus primarily on the following three points. First, they underline the design of courses and integrate the contents of ideological and political education into all courses. Medical courses, including basic public courses, professional core courses, and practical education courses, are required to adhere to the characteristics of medicine, while the nature of the courses must include ideological and political goals to strengthen them and thereby meet professional requirements. Second, they highlight the teaching process and require teachers to implement curriculum ideology and politics into core teaching elements, such as training plans, syllabuses, teaching methods, and textbooks. Third, they emphasize the effects of teaching and education. For medical students, this mainly focuses on the cultivation of the medical humanistic spirit and investigates the improvement of medical humanistic literacy and cultivation of the medical spirit of students after receiving the course ideological and political education.
2.2.2 The core elements of scholars’ ideological and political research regarding medical courses
In 1959, Bloom, an American psychologist, divided the education goals into three categories: the cognitive, affective, and operational domains. In China, Xie et al. (13) proposed a three-dimensional teaching model based on the tangible situation in the country, emphasizing that classroom teaching should be conducted closely around three dimensions; that it should not only focus on knowledge, skills, processes, and methods, but also on emotional attitudes and values. Combined with the government’s documented requirements related to the ideological and political construction of China’s curriculum and the goal of education for medical students, the value guidance in morality education corresponds to the emotional field in Bloom’s educational goal taxonomy. This encourages teachers to enhance the education and guidance related to values in the curriculum. Moreover, this aligned the classroom teaching with the cognitive domain in Bloom’s taxonomy of educational goals and further strengthened teachers’ main position in classroom teaching. In addition, aligning ability development in practical teaching with operational areas in Bloom’s taxonomy of educational goals should strengthen students’ gains and growth in the educational process. This is in line with the reality of Chinese education. This study considered these three goals as the first-level indicators of the Chinese ideological and political curriculum and teaching evaluation system (Figure 1), which can be used to construct other sub-indicators.
The second- and third-level indicators mainly corresponded to the educational connotation of the first-level indicators. Keywords were used to search domestic and foreign literature, and evaluation index elements were extracted from the literature. This study cultivated three keywords: the value lead, knowledge teaching, and ability development. These were combined with curriculum ideology and politics, and medicine for the literature retrieval. As there is no such thing as an ideology and politics course outside of China, these words were replaced by words, such as citizenship curriculum, medical humanities, and moral education, thereby identifying value-led secondary metrics. The key to the ideological and political construction of the curriculum is the teachers, the foundation is the curriculum, and the results come from the students. Therefore, the two first-level indicators of value guidance and knowledge transfer were the two first-level evaluation targets, which focused on teachers. The results mainly reflected ability development, and the evaluation focused on students (14). Value guidance should first consider teachers’ ideological understanding and then teachers’ own theoretical level of understanding and implementation ability (14).
Regarding knowledge transfer, professional and humanistic knowledge should be an important part of medical courses (15). Furthermore, teaching methods involve selecting and applying teaching forms and the effect of knowledge transfer (16, 17). Ability training mainly reflects the effect of education. In medical classrooms, ideological and political education is an important carrier of medical humanities education (18). Moreover, the implementation effect of the ideological and political curriculum reflects the cultivation of students’ humanistic spirit (19) and the development of their professional and scientific spirit (20). Therefore, the evaluation index system was initially divided into three first-level indicators, nine second-level indicators, and 27 third-level indicators, and expert consultations were conducted.
2.3 Establishment of evaluation index system
To verify the scientific value of the constructed index system, 13 medical education experts from Zhejiang University, Wuhan University, Anhui Medical University, Xuzhou Medical University, Wenzhou Medical University, and other universities were randomly selected, and the Delphi method was used to organize the expert consultations. Of the 13 experts, all had senior technical qualifications, 53.85% were very familiar with ideological and political teaching reform, while 46.15% were relatively familiar; further, 38.46% were very familiar with medical humanities education, while 61.54% were relatively familiar, representing the level of medical education in the country.
Questionnaires were distributed, and 13 valid responses were obtained for a 100% recovery rate. Answers were rated on a five-point Likert scale (5 = very important, 1 = unimportant). Each indicator required feedback; therefore, 13 experts gave feedback on the first-level indicators 39 times, second-level indicators 117 times, and third-level indicators 351 times. The specific statistical results are illustrated in Table 3.
Table 3. Feedback from experts on the evaluation index system
Index
|
Very Important or Important
|
Generally Important
|
Unimportant or Very Unimportant
|
|
Number of Indicators
|
Percentage
|
Number of Indicators
|
Percentage
|
Number of Indicators
|
Percentage
|
First-level indicator
|
35
|
89.74%
|
2
|
5.12%
|
1
|
2.56%
|
Second-level indicator
|
104
|
88.89%
|
13
|
11.11%
|
1
|
0.85%
|
Third-level indicator
|
326
|
92.88%
|
22
|
6.27%
|
3
|
0.85%
|
Among the first-level indicators, the generally important and unimportant indicators selected by experts mainly focused on evaluating knowledge transfer. Among the second-level indicators, the generally important and unimportant indicators selected by experts mainly focused on theoretical literacy, implementation ability, professional knowledge, teaching method, job awareness, scientific pursuit, and other evaluation points. Among the third-level indicators, the experts’ selection of generally important and unimportant indicators mainly corresponded to the selection of second-level indicators. For the unimportant indicators, the experts gave suggestions for revision, such as changing ability training from the first-level indicators to quality training, implementation ability from the second-level indicators to value judgment or personality building, post awareness from the secondary indicators to professional quality or post competency, and discussion teaching method from the third-level indicators to the experiential teaching method. The experts’ advice and analysis results produced the ‘Ideological and Political Teaching Evaluation Index System for Medical Courses’, as illustrated in Table 4.
[Table 4 here]
Table 4. The evaluation index system of ideological and political teaching in medical courses
First-level indicator
|
Second-level indicator
|
Third-level indicator
|
Evaluation object
|
1. Value guidance
|
1.1 Ideological awareness
|
1.1.1 Cognition of the importance of ideological and political courses
|
Teacher
|
1.1.2 Conscious behavior of ideological and political curriculum implementation
|
1.1.3 Understanding the relationship between ideological curriculum and medical humanities
|
1.2 Theoretical literacy
|
1.2.1 Mastering the connotation of ideological and political courses
|
1.2.2 The educational discourse system of the ideological and political curriculum
|
1.2.3 The educational characteristics of the ideological and political curriculum
|
1.3 Value judgment
|
1.3.1 Clarify the ideological and political goals of the course
|
1.3.2 Mining the ideological and political elements of the course
|
1.3.3 Course ideology and professional fit
|
2. Knowledge transfer
|
2.1 Professional knowledge
|
2.1.1 Summative assessment results of professional knowledge
|
Teacher
|
2.1.2 Process assessment results of professional knowledge
|
2.2 Humanities knowledge
|
2.2.1 The first classroom integration of medical humanities knowledge
|
2.2.2 The second classroom design of medical spiritual education
|
2.3 Teaching method
|
2.3.1 Case lectures on ideology and politics in medical courses
|
2.3.2 Implementation of experiential teaching method
|
3. Quality training
|
3.1 Human Spirit
|
3.1.1 The establishment of national spirit
|
Student
|
3.1.2 The cultivation of patriotism
|
3.1.3 The establishment of the concept of life first
|
3.1.4 The development of humanistic care
|
3.2 Professionalism
|
3.2.1 A clearer understanding of the profession
|
3.2.2 Love your profession more
|
3.2.3 Have a clear career development plan
|
3.2.4 Greater sense of social responsibility
|
3.3 Scientific pursuit
|
3.3.1 Greater desire for truth-seeking knowledge
|
3.3.2 Clarify innovative thinking
|
3.3.3 Strengthen ideals and beliefs
|
3.3.4 Solve problems more easily
|
2.4 Weight analysis of the evaluation index system
The weights indicated a quantitative distribution of the importance of different aspects of the objects evaluated in the evaluation process, and the role of each evaluation factor in the overall evaluation was treated differently. In the early 1970s, American operations researcher Saaty TL proposed the analytic hierarchy process (AHP), a decision-making method combining quantitative and qualitative methods. The AHP provides a quantitative basis for analyzing, making decisions, predicting, or controlling development by comparing multiple related factors, layer by layer. Through the AHP, the content of the developed index system was evaluated and scored, and the weight coefficient of each index was confirmed; finally, the ‘Evaluation Index System of Ideological and Political Teaching in Medical Courses’ was formed. This was a multi-level complex data system composed of many interrelated and mutually restrictive factors, which not only required in-depth analyses of the experts’ hierarchical evaluation but also aided in decision-making based on the opinions of each expert. The AHP is an effective method to solve this problem. The following steps were implemented:
- The relationship between various factors in the system was analyse, and the hierarchical structure of the system was established. The structure was divided into three layers: target, criterion, and program. The criterion layer could have multiple sub-layers.
- A pairwise comparison matrix was constructed, the importance of factors at the same level based on a criterion in the previous layer were compared, and a pairwise comparison judgment matrix was constructed.
- The relative weight of the compared factors to each criterion was calculated based on the comparison matrix, and a consistency test for the matrix was conducted.
- A combined weight and consistency check of the scheme layer in relation to the target layer was performed.
- Based on the evaluation results of each expert, the comprehensive weight of each indicator in the scheme layer—relative to the target layer—was calculated.
2.4.1 Model building
The hierarchical structure of the evaluation index system was divided into four layers. The first layer was the target layer (O); that is, the quantitative ranking of the evaluation indicators of ideological and political teaching in medical courses. The second layer was the criterion layer I (A); that is, the primary evaluation index factors of ideological and political teaching in medical courses, which were value guidance (A1), knowledge transfer (A2), and quality training (A3). The third layer was criterion layer II (B), which was nine evaluation index factors further decomposed from the primary evaluation index factors; these were recorded as Bi (i = 1, 2, 9). The fourth layer was the program layer (C), which was the 27 evaluation index factors Cj (j = 1, 2, 37).
2.4.2 Constructing the evaluation matrix
Based on the actual indicators of ideological and political teaching evaluation for medical courses, this study considered the role of various criteria- and program-level indicators in evaluating ideological and political teaching of courses. An evaluation matrix was constructed by comparing the influence of each factor at the same level on the relevant factors in the previous level—that is, comparing the factors at the same level in pairs. The construction of the evaluation matrix used the AHP for the expert scoring and weighting method, meaning that the relative importance was described by expert scoring, after which the weight was calculated. The average value of the analysis items was calculated. The relative importance was obtained using the average value information, and the judgment matrix—required by the AHP—was constructed. The AHP hierarchy analysis judgment matrix of the first-level index is shown in Table 5.
Table 5. AHP evaluation matrix for first-level indicators
Mean
|
Indicator item
|
Value guidance
|
Knowledge transfer
|
Quality training
|
4.923
|
Value guidance
|
1
|
1.208
|
1.123
|
4.077
|
Knowledge transfer
|
0.828
|
1
|
0.930
|
4.385
|
Quality training
|
0.891
|
1.075
|
1
|
Note: The mean was the average of 13 experts who rated the importance of this indicator. The judgment matrix was calculated using the ratio of the averages. For example, 0.828 indicates the importance of knowledge transfer relative to value guidance. This value = the average value of knowledge transfer/average value of knowledge transfer; that is, 0.828 = 4.077/4.923.
2.4.3 Weight determination and consistency check
For the third-order evaluation matrix, which was constructed using value guidance, knowledge transfer, and quality training, the AHP hierarchy method was used. Further, the sum-product method was used to calculate the weight and maximum eigenvalue. The basic steps were as follows.
Table 6. The first-level indicator AHP analysis hierarchy process results
Indicator item
|
|
Weights
|
The largest eigenvalue
|
CI value
|
Value guidance
|
1.103
|
36.782%
|
3.000
|
0.000
|
Knowledge transfer
|
0.914
|
30.460%
|
Quality training
|
0.983
|
32.759%
|
CI: Confidence Interval
The average random consistency index (RI) was obtained by repeatedly calculating the eigenvalues of the random evaluation matrix and taking the arithmetic average. Generally, the average RI of the evaluation matrix repeated 1000 times was used, as illustrated in Table 7. The consistency ratio (CR) was calculated as follows:
In this study, a third-order evaluation matrix was constructed, corresponding to Table 7. The RI value was obtained by querying to 0.52, and the CR value was calculated. In general, smaller CR values indicated better consistency of the evaluation matrix. A CR value below 0.1 indicated that the evaluation matrix satisfied the consistency test. A CR value above 0.1 would indicate a lack of consistency, and the evaluation matrix would need to be appropriately adjusted and analysed again. The confidence interval (CI) value calculated for the third-order evaluation matrix was 0.000, and the RI value was 0.520. Therefore, the calculated CR value was 0.000 < 0.1 (Table 8), indicating that the evaluation matrix in this study satisfied the consistency test, and the calculated weights were consistent. This process was repeated for the secondary and tertiary indicators, and the results are detailed in the appendix.
Table 7. Random consistency RI table
n order
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
9
|
10
|
11
|
12
|
13
|
14
|
15
|
RI value
|
0
|
0
|
0.52
|
0.89
|
1.12
|
1.26
|
1.36
|
1.41
|
1.46
|
1.49
|
1.52
|
1.54
|
1.56
|
1.58
|
1.59
|
Table 8. Summary of the consistency test results of the first-level indicators
The largest characteristic root
|
CI value
|
RI value
|
CR value
|
Consistency check results
|
3.000
|
0.000
|
0.520
|
0.000
|
Pass
|