Abstract Domain Name System (DNS) is a basic and important services on the Internet. However, Distributed Denial of Service (DDoS) has been a threat to the security and stability of DNS for a long time. In this paper, we take a review of DDoS attacks based on DNS aiming to make a better understanding of it. Firstly, we analyse the security vulnerabilities of DNS related to denial-of-service attack. Then we discuss the classification of DNS DDoS attacks, and divide them into four categories according to the attack mode. Finally, we summarize the existing defense methods of two aspects. We aim to get a better understanding of the DDoS attacks based on DNS and expand the understanding of DDoS attacks.
Abstract Background: Academically talented high school students (ATHSSs), an exceptional cohort, are not well studied for their career expectations, especially for those with medical career expectation (MCE). Nowadays, the public perception of the medical profession is changing in China. The purpose of this study was to answer questions about ‘is medicine attractive for ATHSSs and ‘what factors affect medical career expectations (MCE) for ATHSSs’ in China. Methods: A total of 16,479 representative ATHSSs in senior three completed a questionnaire and four different academic tests. Frequency statistics showed the proportion of ATHSSs with MCE. Unpaired t-tests were performed to find out the differences in demographics, family background, and academic performance between students with and without MCE. The logit models analysis were applied to explore the potential factors that affected the MCE of this exceptional group of students. Results: ATHSSs with MCE accounted for 20.6% (ranking 7/18) of the respondents. They were more likely to be female, came from relatively poorer families, lived in a rural area, and performed significantly worse in all academic tests except for mathematics, compared with those without MCE. In addition, the results revealed that gender (β=-0.436, p<0.01), region of hometown (β=-103, p<0.1), mother’s years of schooling (β=-0.019, p<0.05), and father’s occupational status (β=-0.005, p<0.01) contributed significantly to the MCE of academically talented students. Better performance in mathematics affected the MCE of ATHSSs taking the liberal arts and science tests differently. Conclusions: We found the medical career is becoming unattractive to academically talented students and the medical career may be loosing their aura in China. Students who have medical career expectations are likely to be females and to have a weak family background. We discuss implications for medical education.
Purpose: The 8-year medical education program (EYMEP) is China’s path to training high-level medical talents. In retrospect, this study systematically reviewed the developmental process of China’s EYMEP. The status quo and characteristics, and threats and challenges, were analyzed, along with the program’s prospects. Design/Approach/Methods: This study analyzed relevant textual materials and policy documents dating back to the time of hosting of China’s EYMEP, as well as conducted various specific interviews and field trips. Findings: The exploration of China’s high-level medical talent training has been conducted over a century. EYMEP can be divided into five periods: the Only Host Period, the Duplication Pilot Host Period, the Expansion Period, the Joint Exploration Period, and the In-Depth Promotion Period. Currently, there are 14 universities and institutes hosting the EYMEP approved by the Ministry of Education of the People’s Republic of China. However, they differ greatly in training ideas and goals, enrollment processes, and training phases. China’s EYMEP is faced with some external threats and internal challenges. In the future, China’s EYMEP should consider five aspects. Originality/Value: In the new era of the reform and development of China’s medical education, a systematic review of the development of EYMEP in China is of great significance to the promotion of high-level medical talent training in China. Meanwhile, the exploration course of China’s high-level medical talent training represented by the EYMEP may be an enlightenment for other countries, especially developing countries like China, in their training of high-level medical talents.
Objectives To evaluate the effect of the Education and Training Programme for Excellent Physicians in China on medical students’ academic performance. Design This study is a secondary analysis of data from a cross-sectional survey of China Medical Student Survey (CMSS, 2021) and administrative data of the first-stage Medical Licensing Examination—the Standardised Competence Test for Clinical Medicine Undergraduates (the Test, 2021). CMSS used a stratified sampling process, with all undergraduate clinical medicine students participating voluntarily. Setting This programme is implemented at the class level within reformed medical schools, targeting undergraduate students in 5-year clinical medicine in China. The reformed medical schools run pilot classes and traditional classes simultaneously. The analytic sample was a total of 12 243 observations from pilot and traditional classes in 34 medical schools which implemented the reform across 19 provinces in China. Methods This study applied the propensity score matching method to estimate the effect of the reform by comparing the scores of the Test between pilot and traditional classes within the same medical schools. We further explored the potential mechanisms driving the effect from two facets of the Test: medical knowledge modules and cognitive levels. Results Pilot classes outperformed traditional classes by 0.104 SD on the Test (95% CI 0.037 to 0.171). Improvements were seen in basic medicine and clinical medicine modules (0.109 and 0.101 SD, respectively) and cognitive levels of memorisation and application (0.116 and 0.111 SD, respectively). Conclusion These results suggest that the reform had a significant positive impact on medical students’ academic performance. Based on the components of this reform and the potential mechanism analysis of the two facets, this study indicates that curriculum reform in integrated learning and teaching methods reform in the adoption of problem-based learning may have been the possible drivers of this positive impact.
Background: It is vital to cover wound management knowledge and operations in the early stages of resident training.With this in mind, a simulated wound management course for postgraduate year one surgery residents (PGY1s) was designed and its effectiveness was evaluated.Methods: A retrospective quasi-experimental method was used.PGY1s in 2014 constituted the control group, and PGY1s in 2015 and 2016 constituted the intervention group.The course given to the control group comprised didactic teaching followed by deliberate practice plus immediate personalized feedback.The newly designed course given to the intervention group was reconstructed and disassembled into four components according to the simulation-based mastery learning model, which were baseline test, interactive learning, basic skills practice, and reflective learning.The same performance assessments were used in the control and intervention group, including process measurement and outcome measurement. Results:The process measurement showed that the intervention group's scores were significantly higher in the "dissociation of subcutaneous tissue" and "quality of suturing and knots".The outcome measurement showed that the accuracy of debridement was greatly improved and both key and total suture numbers were significantly higher in the intervention group.Conclusions: Simulation-based mastery learning was incorporated into our proposed course framework, promoting the learning outcome of PGY1s
This study contributes evidence on the impact of developmental advising using a national sample of students in the undergraduate clinical medicine program in China (n = 122,932). Using a combination of instrumental variable regression and structural equation modeling, the study explored beyond low-touch informative intervention and fully presented how developmental advising makes effects. A significantly positive advising effect on both academic and non-academic indicators was found, and it varies by the students' demographic features, family backgrounds, and pre-college experiences, suggesting its potential to address achievement gaps across students from different backgrounds. In addition, the mediating roles of self-efficacy and learning engagement that enable advising to impact academic improvement were verified, shedding light on how developmental advising impacts students' development.
The needs-based shortage of healthcare workers is severe worldwide and it would be exacerbated if many medical students switch to other careers after graduation. Maintaining and improving the career commitment of medical students, which could be a feasible, effective, and scalable way to reduce the attrition rate, is essential in medical education. We designed a randomized experiment to test whether an information intervention based on role modeling could enhance medical students' career commitment. In the randomized experiment, the sample (N = 36,482) was divided into the treatment group (N = 18,070) and the control group (N = 18,412). The intervention information consisted of image-text messages on Zhong Nanshan, who is an inspiring role model for he went to the frontline of COVID-19 in the most critical circumstances and received praise and affirmation from the public. Α difference-in-differences model was employed to identify the effect of the information intervention. Heterogeneous treatment effects were identified using sub-sample analyses. The results showed that the information intervention statistically significantly reduced medical students' dropout intention by 2.7 percentage points (95% CI: -0.037 to -0.016, t = -4.95, p < 0.001), equivalent to 14.6% of the control group mean. This estimate indicates that the information intervention could significantly increase the career commitment of medical students. Finally, male and senior students were influenced more than their female and junior counterparts, which can be explained by their relatively high dropout intention. Role model-based information intervention improves the career commitment of medical students. The underlying behavioral model is that, when students use a role model as their reference point, they consider dropout as a substantial welfare loss. Role modeling is an effective way to improve the career commitment of medical students, especially for males and senior students.
Abstract Background Fostering empathy has been continuously emphasized in the global medical education. Empathy is crucial to enhance patient-physician relationships, and is associated with medical students’ academic and clinical performance. However, empathy level of medical students in China and related influencing factors are not clear. Methods This was a cross-sectional study among medical students in 11 universities. We used the Jefferson Scale of Empathy Student-version of Chinese version to measure empathy level of medical students. Factors associated with empathy were identified by the univariate and multivariate logistic regression analyses. Based on the variables identified above, the nomogram was established to predict high empathy probability of medical students. Receiver operating characteristic curve, calibration plot and decision curve analysis were used to evaluate the discrimination, calibration and educational utility of the model. Results We received 10,901 samples, but a total of 10,576 samples could be used for further analysis (effective response rate of 97.02%). The mean empathy score of undergraduate medical students was 67.38 (standard deviation = 9.39). Six variables including gender, university category, only child or not, self-perception doctor-patient relationship in hospitals, interest of medicine, Kolb learning style showed statistical significance with empathy of medical students ( P < 0.05). Then, the nomogram was established based on six variables. The validation suggested the nomogram model was well calibrated and had good utility in education, as well as area under the curve of model prediction was 0.65. Conclusions We identify factors influencing empathy of undergraduate medical students. Moreover, increasing manifest and hidden curriculums on cultivating empathy of medical students may be needed among medical universities or schools in China.
Objectives (1) Understanding the characteristics of online learning experiences of Chinese undergraduate medical students; (2) Investigating students’ perceptions of ongoing online education developed in response to COVID-19 and (3) Exploring how prior online learning experiences are associated with students’ perceptions. Design Students’ familiarity with online learning modes and corresponding perceived usefulness (PU) according to their previous experiences were investigated using an online survey. The survey also collected data on students’ perceptions through their evaluation of and satisfaction with current online learning. Setting In response to the educational challenges created by COVID-19, medical schools in China have adopted formal online courses for students. Participants The questionnaire was sent to 225 329 students, of whom 52.38% (118 080/225 329) replied, with valid data available for 44.18% (99 559/225 329). Methods Pearson correlations and t-tests were used to examine the relationship between familiarity and PU. Multiple linear regression and logistic regression analyses were used to determine the impact of prior learning experiences and its interactions with gender, area, learning phase and academic performance on students’ perceptions. Results Students’ PU had a significant positive correlation with their familiarity with online learning modes (p<0.01). Students’ evaluation of and satisfaction with their current online education were positively associated with their familiarity (β=0.46, 95% CI 0.45 to 0.48, p<0.01; OR 1.14, 95% CI 1.13 to 1.14, p<0.01) with and PU (β=3.11, 95% CI 2.92 to 3.30, p<0.01; OR 2.55, 95% CI 2.37 to 2.75, p<0.01) of online learning. Moreover, the higher the students’ learning phases, the lower the associations between PU and students’ evaluation of and satisfaction with ongoing online education. Conclusions Medical students in China have experiences with various online learning modes. Prior learning experiences are positively associated with students’ evaluation of and satisfaction with current online education. Higher learning phases, in which clinical practices are crucial, and high academic performance led to lower evaluation and satisfaction scores.
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