Using elements from an acute abdominal pain Objective Structured Clinical Examination (OSCE) leads to more standardized grading in the surgical clerkship for third-year medical students

Computer-generated structured electronic medical records are preferable to conventional medical records for patients with acute abdominal pain - a prospective, double-blinded study

Objectives

Structured medical records improve readability and ensure the inclusion of information necessary for correct diagnosis and treatment. This is the first study to assess the quality of computer-generated structured medical records by comparing them to conventional medical records on patients with acute abdominal pain.

Materials and methods

A prospective double-blinded study was conducted in a tertiary referral center emergency department between January 2018 and June 2018. Patients were examined by emergency department physicians and by experience and inexperienced researcher. The researchers used a new electronical medical records system, which gathered data during the examination and the system generate structured medical records containing natural language. Conventional medical records dictated by physician and computer-generated medical records were compared by a group of independent clinicians.

Results

Ninety-nine patients were included. The overall quality of the computer-generated medical records was better than the quality of conventional human-generated medical records – the structure was similar or better in 99% of cases and the readability was similar or better in 86% of cases, p < 0.001. The quality of medical history, current illness, and findings of physical examinations were likewise better with the computer-generated recording. The results were similar when patients were examined by experienced or inexperienced researcher using the computer-generated recording.

Discussion

The quality of computer-generated structured medical records was superior to that of conventional medical records. The quality remained similar regardless of the researcher’s level of experience. The system allows automatic risk scoring and easy access for quality control of patient care. We therefore consider that it would be useful in wider practice.

Using a station within an objective structured clinical examination to assess interprofessional competence performance among undergraduate nursing students

AIM/OBJECTIVE

To describe and analyse the use of a station within an OSCE to assess interprofessional competence performance in undergraduate nursing students. The specific objectives were: - To measure the students' level of competence performance in relation to the interprofessional competences Roles and Responsibilities, Communication and Teamwork. - To determine inter-observer concordance in the assessment of the interprofessional competences.

BACKGROUND

Teamwork competencies are key to improving patient safety and avoiding medical errors. Today, healthcare professionals work in interdisciplinary teams. To foster a culture of safety, some of the measures that can be taken at the individual, team and organisational levels include fostering clear communication among team members, knowledge of respective roles and functions, and deepening team functioning through respect and trust in judgement and capabilities. The World Health Organization recommends starting to develop these competencies in university studies, through interprofessional education. There are numerous programmes in universities all over the world, but more research is needed on the assessment of interprofessional education activities, preferably through objective methods. Competency performance can be assessed by an external evaluator, in a simulated environment, with the Objective Structured Clinical Examination, which is widely used in nursing.

DESIGN

Cross-sectional study.

METHODS

63 second-year nursing undergraduate students completed an interprofessional competencies station within an 8-station OSCE. Communication, Roles and Responsibility and Teamwork competences were assessed. The Interprofessional Collaborator Assessment Rubric (ICAR) was used as a model to assess the performance of students. Inter-observer concordance analysis was performed using the kappa coefficient and the concordance rate.

RESULTS

92.1% of students reached a good level in communication competence, 88.9% in roles and responsibility competence, and 55.6% in teamwork competence. The global concordance rate was 83.8%, and the kappa coefficient was 0.67.

CONCLUSIONS

Most students have demonstrated interprofessional competence performance at a good level. However, the inter-observer concordance obtained for some of the items was not as expected. The assessment of interprofessional competencies, as it deals mainly with relational and communicative aspects, requires greater preparation both in terms of the specification of assessment items and in agreement between examiners.

Teaching and Assessment of High-Velocity, Low-Amplitude Techniques for the Spine in Predoctoral Medical Education

Although national didactic criteria have been set for predoctoral education and assessment in osteopathic manipulative treatment, there is no criterion standard for teaching methods and assessments of osteopathic manipulative treatment competence in colleges of osteopathic medicine. This issue is more pressing with the creation of the single graduate medical education accreditation system by the American Osteopathic Association and Accreditation Council for Graduate Medical Education, which introduced the creation of "osteopathic recognition" for residencies that want to incorporate osteopathic principles and practice into their programs. Residencies with osteopathic recognition may include both osteopathic and allopathic graduates. Increased standardization at the predoctoral level, however, is recommended as osteopathic principles and practice training applications are expanded. The objectives of this article are to review the standards for teaching osteopathic medical students high-velocity, low-amplitude (HVLA) techniques for the spine; to review and discuss the methods used to assess medical students' proficiency in using HVLA; and to propose baseline standards for teaching and assessing HVLA techniques among medical students.

The Surgical Clerkship and Medical Student Performance in a Standardized Patient Case of Acute Cholecystitis

BACKGROUND

Although an Observed Structured Clinical Examination (OSCE) has been used to evaluate patient interaction and general knowledge competencies of third-year students during their required surgical clerkships, whether surgical clerkship experience predicts satisfactory performance with a surgical patient in an OSCE environment has not been investigated.

OBJECTIVE

We hypothesized that completion of the third-year surgery clerkship would improve student ability to diagnose acute cholecystitis and recognize the further need for hospital admission and treatment.

DESIGN

An observational study design was used to determine student skills in evaluating a simulated surgical patient with abdominal pain from acute cholecystitis. The skills included key data gathering, physical examination, and information-sharing tasks.

SETTING

Tertiary care academic medical center.

PARTICIPANTS

Performance was compared between a cohort of 101 medical students who had completed the third-year surgical clerkship and 72 who had not. A secondary analysis compared performance for 91 students who had completed their third-year clerkship in sites near the University of California, San Francisco School of Medicine, and 10 who did so at a regional campus geographically distant from the medical school.

RESULTS

Of the 173 students who participated in the OSCE, only 42% correctly identified the diagnosis of acute cholecystitis, though 71% did suggest the possibility of a biliary process to the standardized patient. Most of the students who identified the condition as acute cholecystitis or gallbladder-related process had completed their third-year surgical clerkship (odds ratio [OR] = 3.26). Students who completed their surgical clerkship were also better able to recommend appropriate treatment for the patient (OR = 2.35), and recommend admission to the hospital or emergency department (OR = 2.00). Approximately one-third (35.3%) of all students documented a positive Murphy's sign, but only 6.4% identified the triad of leukocytosis, fever, and a Murphy's sign as diagnostic of acute cholecystitis and the need for surgical intervention. Student performance on the clinical examination did not differ depending on whether the students completed their clerkship at a Bay Area or regional hospital.

CONCLUSIONS

Student recognition of the key physical examination and laboratory findings diagnostic of acute cholecystitis was low, but students were better able to recommend further treatment for a patient with acute cholecystitis after completing the third-year surgical clerkship. Our study reveals areas where surgical educators can improve medical student ability to accurately diagnose acute cholecystitis and evaluate acute abdominal processes.

Communication skills training in surgical residency: a needs assessment and metacognition analysis of a difficult conversation objective structured clinical examination

BACKGROUND

The objective structured clinical examination (OSCE) can be used to evaluate the Accreditation Council for Graduate Medical Education Core Competencies of Professionalism and Interpersonal and Communication Skills. The aim of this study was to describe general surgery resident performance on a "difficult conversation" OSCE.

METHODS

In this prospective study, junior and senior residents participated in a 2-station OSCE. Junior stations involved discussing operative risks and benefits and breaking bad news. Senior stations involved discussing goals of care and discussing transition to comfort measures only status. Residents completed post-OSCE checklist and Likert-based self-evaluations of experience, comfort, and confidence. Trained standardized patients (SPs) evaluated residents using communication skill-based checklists and Likert-based assessments. Pearson correlation coefficients were determined between self-assessment and SP assessment. Mann-Whitney U tests were conducted between junior and senior resident variables, using α = 0.05.

RESULTS

There were 27 junior residents (age 28.1 ± 1.9 years [29.6% female]) and 27 senior residents (age 32.1 ± 2.5 years [26.9% female]). The correlation of self-assessment and SP assessment of overall communication skills by junior residents was -0.32 on the risks and benefits case and 0.07 on the breaking bad news case. The correlation of self-assessment and SP assessment of overall communication skills by senior residents was 0.30 on the goals of care case and 0.26 on the comfort measures only case. SP assessments showed that junior residents had higher overall communication skills than senior residents (p = 0.03). Senior residents perceived that having difficult conversations was more level appropriate (p < 0.001), and they were less nervous having difficult conversations (p < 0.01) than junior residents.

CONCLUSIONS

We found that residents perform difficult conversations well, that subjective and objective skills are correlated, and that skills-based training is needed across all residency levels. This well-received method may be used to observe, document, and provide resident feedback for these important skills.

Cutting too deep? Assessing the impact of a shorter surgery clerkship on students' clinical skills and knowledge

BACKGROUND

The aim of this study was to compare the performance of students completing an 8-week versus a 6-week surgery clerkship on an objective structured clinical examination (OSCE) and the National Board of Medical Examiners (NBME) clinical science surgery examination.

METHODS

One hundred fifteen students from the 8-week clerkship and 99 from the 6-week clerkship were included. Performance on a summative OSCE was assessed using behaviorally anchored checklists. NBME exams were graded using the NBME's standard scaled scores. Results were compared using 2-tailed, independent-samples, unequal-variance t tests.

RESULTS

Mean OSCE scores for the 8-week and 6-week curricula were not statistically different. Mean NBME scores also did not statistically differ. Six-week students performed significantly better in the specific OSCE subdomains of blood pressure, orthostatic blood pressure, rectal exam, and fecal occult blood test.

CONCLUSIONS

Overall OSCE and NBME exam performance did not differ between 8-week and 6-week surgery clerkship students.