Accuracy of medical student electronic logbook problem list entry

Investigating the advantages and disadvantages of electronic logbooks for education goals promotion in medical sciences students: A systematic review

Background and Aims

Electronic logbook (E-Logbook) is one of the practical software in medical science that serves as an auxiliary tool for comprehensive education, formative evaluation, and student learning documentation in clinical education. E-logbooks are available to people on the Internet without any time or place restrictions. Experts' familiarity with e-logbooks and their advantages and disadvantages can be effective in their better design so professors and students can use their potential benefits. Therefore, this study examines the advantages and disadvantages of an e-logbook.

Methods

This systematic review was conducted until June 13, 2022, by searching relevant keywords such as logbook, e-logbook, and medical students in PubMed, Scopus, and Web of Science databases. Data were extracted using the data extraction form. The contents of the studies were analyzed based on the study's aim. The results of the analyses were presented in the form of descriptive statistics (tables and figures).

Results

Out of 365 retrieved studies, 13 were selected to investigate the advantages and disadvantages of e-logbooks. Most studies were conducted in Pakistan (n = 4) and focused on medical students with different specialties (n = 10). The advantages and disadvantages of e-logbooks were classified into nine and four categories, respectively. Most advantages of e-logbooks were related to monitoring and evaluating the performance of students and instructors (n = 11). Their most disadvantages were associated with hardware and software (n = 8).

Conclusion

According to the results, e-logbooks can improve clinical education, provide feedback to people, control the achievement of educational goals, and increase professor-student interaction. Hence, it is recommended to address their disadvantages and barriers to improve the quality of students' performance.

A paediatric logbook: Millstone or milestone?

Logbooks are ubiquitous in undergraduate and postgraduate medical education. Here, two alumni who are in the early phase of their career, reflect on their experience in their undergraduate paediatric term and how this was shaped by their mandatory paediatric logbook.

Clinical Procedure Experience of Medical Students Improves Their Objective Structured Clinical Examination Station Scores in Emergency Medicine Clerkship

OBJECTIVE

We aimed to study the correlation between procedure experiences in the clinical setting and objective structured clinical examination (OSCE) scores achieved at the end of an emergency medicine clerkship for the final-year medical students.

METHODS

This is a retrospective analysis of prospectively collected clinical data of 141 final-year medical students and their OSCE scores for the two consecutive academic years (2015-2017). The experience of practical skills including suturing, extended focused assessment sonography for trauma (EFAST), airway management, and cardiopulmonary resuscitation was correlated with the final OSCE scores in the same areas.

RESULTS

Weighted experiences of the four procedures were significantly correlated with the total OSCE station scores (p = 0.027, Spearman's rho = 0.19). Suturing OSCE scores were significantly higher than the other stations (p < 0.0001, Wilcoxon signed-rank test). There was a significant correlation between suturing experience and its OSCE score (p = 0.036, Spearman's rho = 0.18). There was also a strong trend in correlation between EFAST experience and its OSCE score (p = 0.063, Spearman's rho = 0.16). There was a significant difference in weighted experience between each of the four procedures (p < 0.0001, Wilcoxon signed-rank test). In all cut-off levels (75-95) of OSCE scores, students showed higher weighted procedure experience for those who had higher scores. Statistical significance was found only for students who scored more than 90% of the OSCE score.

CONCLUSION

Clinical experience of procedures improved OSCE scores of the same procedures. The top students showed significant higher weighted procedure experience.

Feedback learning opportunities from medical student logs of paediatric patients

BACKGROUND

Feedback can alter medical student logging practices, although most learners feel feedback is inadequate. A varied case mix in rural and urban contexts offers diverse clinical encounters. Logs are an indicator of these clinical experiences, and contain opportunities for feedback, which can greatly influence learning: we labelled these 'feedback learning opportunities' (FLOs). We asked: How often do FLOs occur? What are the case complexities of rural compared to urban paediatric logs? Do more complex cases result in more FLOs?

METHODS

In Western Australia, 25% of medical students are dispersed in a Rural Clinical School (RCSWA) up to 2175 miles (3500 km) from the city. Urban students logged 20 written cases; rural students logged a minimum of 25 paediatric cases electronically. These were reviewed to identify FLOs, using a coding convention. FLO categories provided a structure for feedback: medical, professionalism, insufficient, clinical reasoning, student wellbeing, quality and safety, and sociocultural. Each log was assigned an overall primary, secondary or tertiary case complexity.

RESULTS

There were 76 consenting students in each urban and rural group, providing 3034 logs for analysis after exclusions. FLOs occurred in more than half the logs, with significantly more rural (OR 1.35 95% CI 1.17, 1.56; p < 0.0001). Major FLOs occurred in over a third of logs, but with no significant difference between rural and urban (OR 1.10 95% CI 0.94, 1.28; p = 0.24). Medical FLOs were the most common, accounting for 64.0% of rural and 75.2% of urban FLOs (OR 1.71 95% CI 1.37, 2.12; p < 0.0001). Students logged cases with a variety of complexities. Most cases logged by urban students in a tertiary healthcare setting were of primary and secondary complexity. Major medical FLOs increased with increasing patient complexity, occurring in 32.1% of tertiary complexity cases logged by urban students (p < 0.001).

CONCLUSIONS

Case logs are a valuable resource for medical educators to enhance students' learning by providing meaningful feedback. FLOs occurred often, particularly in paediatric cases with multiple medical problems. This study strengthens recommendations for regular review and timely feedback on student logs. We recommend the FLOs categories as a framework for medical educators to identify FLOs.

The role of emergency medicine clerkship e-Portfolio to monitor the learning experience of students in different settings: a prospective cohort study

Background

Although emergency departments provide acute care learning opportunities for medical students, student exposure to recommended curriculum presentations and procedures are limited. In this perspective, clinical environments providing learning opportunities for students should be monitored as part of an ongoing quality improvement process. This study aims to analyze student exposures and their involvement levels in two different hospitals (Tawam and Al Ain) so as to improve the teaching and learning activities.

Methods

This is a prospective study on all 76 final year medical students’ electronic logbooks (e-Portfolio) of the academic year 2016/2017.

Results

Students recorded 5087 chief complaints and 3721 procedures. The average patient and procedure exposure in a shift per student in Al Ain Hospital compared with Tawam Hospital were 7.2 vs 6.4 and 5.8 vs 4.3, respectively. The highest full involvement with presentations was seen in the pediatric unit (67.1%, P < 0.0001). Urgent care shifts demonstrated the highest area of “full involvement” with procedures for our students (73.2%, P < 0.0001). Students’ highest involvement with presentations and procedures were found during the night shifts (P < 0.0001, 66.5 and 75.1%, respectively).

Conclusions

The electronic portfolio has proven to be a very useful tool in defining the learning activities of final year medical students during their emergency medicine clerkship and in comparing activities in two different clinical settings. Data collected and analyzed using this e-Portfolio has the potential to help medical educators and curriculum designers improve emergency medicine teaching and learning activities.

Rural Versus Suburban/Urban Experiences in a Family Medicine Preceptorship

PURPOSE

Accreditation standards require physician assistant (PA) programs to ensure students receive adequate clinical experiences. During their clinical year of training, PA students complete rotations with multiple clinical preceptors, introducing them to practice and exposing them to a variety of clinical problems. In this article, we examined Typhon Physician Assistant Student Tracking (PAST) system patient encounter logs' value for program evaluation, but also in research to address questions relevant to PA education. Specifically, we explored the MEDEX Northwest Physician Assistant Training Program student experience across rural versus suburban/urban placements in a 4-month family medicine preceptorship.

METHODS

Student experience was analyzed from 2 years of collected Typhon PAST encounter data. Encounter characteristics included duration, number of clinical problems, student level of responsibility, and decision type. Patient characteristics included sex, age, race, and clinical problems recorded as ICD-9 codes.

RESULTS

Individual student experience varied widely across different preceptors. However, these differences were more specific to the preceptor-student relationship than to whether the site was classified as rural or suburban/urban. Across these settings, significant differences were only noted for percentage of female and 65 or older patient encounters. The most common clinical problems reported across rural versus suburban/urban sites were highly correlated.

CONCLUSIONS

Physician Assistant Student Tracking data demonstrated that individual student experience in their family medicine rotation varied widely. However, in general, rural and suburban/urban experiences were more similar than different. This study supports the value of the Typhon PAST logging system for not only tracking student activity but also addressing program evaluation and research questions.

Novel Examination for Evaluating Medical Student Clinical Reasoning: Reliability and Association With Patients Seen

Background: Medical students learn clinical reasoning, in part, through patient care. Although the numbers of patients seen is associated with knowledge examination scores, studies have not demonstrated an association between patient problems and an assessment of clinical reasoning. Aim: To examine the reliability of a clinical reasoning examination and investigate whether there was association between internal medicine core clerkship students' performance on this examination and the number of patients they saw with matching problems during their internal medicine clerkship. Methods: Students on the core internal medicine clerkship at the Uniformed Services University students log 11 core patient problems based on the Clerkship Directors in Internal Medicine curriculum. On a final clerkship examination (Multistep), students watch a scripted video encounter between physician and patient actors that assesses three sequential steps in clinical reasoning: Step One focuses on history and physical examination; Step Two, students write a problem list after viewing additional clinical findings; Step Three, students complete a prioritized differential diagnosis and treatment plan. Each Multistep examination has three different cases. For graduating classes 2010–2012 (n = 497), we matched the number of patients seen with the problem most represented by the Multistep cases (epigastric pain, generalized edema, monoarticular arthritis, angina, syncope, pleuritic chest pain). We report two-way Pearson correlations between the number of patients students reported with similar problems and the student's percent score on: Step One, Step Two, Step Three, and Overall Test. Results: Multistep reliability: Step 1, 0.6 to 0.8; Step 2, 0.41 to 0.65; Step 3, 0.53 to 0.78; Overall examination (3 cases): 0.74 to 0.83. For three problems, the number of patients seen had small to modest correlations with the Multistep Examination of Analytic Ability total score (r = 0.27 for pleuritic pain, p &lt; 0.05, n = 81 patients; r = 0.14 for epigastric pain, p &lt; 0.05, n = 324 patients; r = 0.19 for generalized edema, p &lt; 0.05, n = 118 patients). Discussion or Conclusion: Although a reliable assessment, student performance on a clinical reasoning examination was weakly associated with the numbers of patients seen with similar problems. This may be as a result of transfer of knowledge between clinical and examination settings, the complexity of clinical reasoning, or the limits of reliability with patient logs and the Multistep.

Could clinical experience during clerkship enhance students' clinical performance?

BACKGROUND

Medical students learn and practice various clinical skills during clinical clerkship. Patient encounters are important for developing clinical thinking, communication skills, and professional attitude. We investigated whether the amount of clinical experience during clerkship correlated with students' clinical competency and students' perception of effectiveness of their clerkship on it.

METHODS

Fourth year medical students undertook the Objective Structured Clinical Examinations (OSCE) in August 2012. Students provided the number of patients for whom they took medical histories or performed physical examinations during clerkship and provided feedback as to whether or not the clinical clerkship was helpful in preparing OSCE. The correlation between the OSCE score and number of patients was analyzed.

RESULTS

One hundred thirty students completed the questionnaire (86.6%). OSCE scores correlated with the total number of patients encountered for physical examinations (correlation coefficient, 0.274; p = 0.0105). Cumulative 3-year GPAs were positively correlated with OSCE scores (correlation coefficient, 0.330; p = 0.0001). Most (92.3%) answered that their clinical clerkship was helpful in preparing them for the OSCE; however, only 20% felt that their clinical clerkship was most helpful. Others felt that role playing (38.46%) or the guide book (33.84%) was most helpful.

CONCLUSIONS

The amount of clinical experience during the students' clerkship had a small but positive relationship with students' clinical performance. Further research to elucidate the influence of clinical experience on clinical competency is needed.

Relationship between clinical experiences and internal medicine clerkship performance

OBJECTIVES

This study was conducted to assess the associations between several clerkship process measures and students' clinical and examination performance in an internal medicine clerkship.

METHODS

We collected data from the internal medicine clerkship at one institution over a 3-year period (classes of 2010-2012; n = 507) and conducted correlation and multiple regression analyses. We examined the associations between clerkship process measures (student-reported number of patients evaluated, percentage of core problems encountered, total number of core problems encountered, total number of clinics attended) and four clerkship outcomes (clinical points [a weighted summation of a student's clinical grade recommendations], ambulatory clinical points [the out-patient portion of clinical points], examination points [a weighted summation of scores on three clerkship examinations], and National Board of Medical Examiners examination score).

RESULTS

After controlling for pre-clerkship ability and gender, percentage of core problems was significantly associated with ambulatory clinical points (b = 3.84, total model R(2) = 0.14). Further, number of patients evaluated was significantly associated with clinical points (b = 0.19, total model R(2) = 0.22), but only for students who undertook first-quarter clerkships, who reported higher numbers of patients.

CONCLUSIONS

Notwithstanding a few positive (but small) associations, the results from this study suggest that clinical exposure is, at best, weakly associated with internal medicine clerkship performance.

Associations between medical student log data and clerkship learning outcomes

BACKGROUND

Largely due to regulatory requirements, medical students increasingly document patient encounters in logs. Prior studies demonstrated value in achieving course objectives but not regarding objective learning outcomes.

PURPOSE

The purpose of this article is to assess the associations between students' log data and clerkship outcomes.

METHODS

We assessed ambulatory, internal medicine-pediatrics clerkship logs. Students recorded patients' diagnoses, preceptor's teaching content and performing histories and physicals (H&P). We examined associations between log data and National Board of Medical Examiners Subject Exams (NBME), Objective Structured Clinical Exams (OSCE), and clinical evaluations.

RESULTS

All 272 students completed logs (M diagnoses = 146.5, SD = 24.9). In univariate analysis number of diagnoses, preceptors' teaching patient management and performing H&P independently correlated with OSCE scores (r = .13-.24, p < .05). NBME scores correlated with diagnoses, performing H&P independently (r = .13-.18, p < .05). Teaching patient management, diagnoses, performing H&P independently were associated with clinical evaluations (all ps < .05). Regressions demonstrated that performing physicals independently was associated with NBME and OSCE scores (p < .05, R (2) = .03 and .05, respectively). Teaching disease management and pediatric diagnoses were associated with clinical evaluations (p < .05) in medicine and pediatrics, respectively.

CONCLUSIONS

Aspects of teaching, increased clinical involvement, and student autonomy were associated with clerkship performance.

Internal medicine core clerkships experience with core problem lists: results from a national survey of clerkship directors in internal medicine

BACKGROUND

The Liaison Committee on Medical Education (LCME) requires clinical clerkships in North American Medical Schools to define and monitor core problems and clinical conditions for medical students and adjust the clerkships to ensure that all students meet those objectives at all instructional sites. Clinical clerkships usually use medical student generated logbooks to meet these requirements. It is not clear what clinical clerkship directors are doing to meet these standards.

PURPOSE

To determine how internal medicine clerkship directors develop problem lists, whether and how they verify student problem list entry, and how missed core problems are covered.

METHODS

The Clerkship Directors in Internal Medicine (CDIM) organization conducts an annual survey of its institutional members (one member per medical school). In 2007, 75% of North American medical schools (82 of 110) responded to the survey, which included questions on core problem lists and medical student logbooks.

RESULTS

Ninety-four percent of responding medical schools had a core problem list for the core internal medicine clerkship. Most schools used an electronic logbook and verified student exposure to core problems (76%). The clerkship director usually did the verification (63%). Clerkships offered a variety of options to remedy lack of exposure to core problems and usually offered more than one option.

CONCLUSIONS

Clerkship directors in internal medicine develop, verify, and ensure exposure to core problems in internal medicine. Most clerkship directors used the CDIM recommended core problem list as a basis for their local core problem list. Emerging computer-assisted learning options may simplify clerkship adjustments for lack of exposure to core problems. It appears that clerkship directors are using logbooks appropriately to meet the LCME charge to monitor core problems and clinical conditions.