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Jewett L, Clarke S, Griffin E, Danielson A. Core and cluster or head to toe?: a comparison of two types of curricula for teaching physical examination skills to preclinical medical students. BMC MEDICAL EDUCATION 2024; 24:337. [PMID: 38532372 DOI: 10.1186/s12909-024-05191-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 02/17/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Despite the central importance of physical examination (PE) skills to patient evaluation, early trainees struggle with its correct application and interpretation. This struggle may reflect the instructional strategies of PE courses which have largely ignored the clinical reasoning necessary to accurately apply these skills. The "core + cluster" (C + C) is a recent approach to teaching PE to clerkship-level medical students that combines a basic 'core' exam with 'cluster' based on the student's hypothesis about their patient's clinical presentation. Our institution developed a novel C + C curriculum to teach PE to preclinical students. We aimed to assess the impact of this new curriculum on students' clinical skills and course evaluations in comparison to the traditional "head-to-toe" approach we'd used previously. METHODS This was a retrospective study comparing two consecutive medical school cohorts exposed to the new (C + C) and prior (HTT) curricula respectively. We studied two complete cohorts of first-year medical students at our institution who matriculated in 2014 and 2015. The 2014 cohort received PE training via an HTT approach. The 2015 cohort received PE training via a C + C approach. Outcomes included performance scores on a statewide clinical performance exam (CPX) and student course evaluations. RESULTS We found no statistically significant difference in mean CPX scores between the two cohorts. However, student course ratings were significantly higher in the C + C cohort and students rated the C + C format as highly useful in clinical encounters. CONCLUSIONS The C + C curriculum appears to be as effective a method of teaching PE to preclinical students as the HTT approach and is better received by students. We believe that this approach more appropriately reflects the way PE is used in clinical encounters and may help students with diagnostic hypothesis generation.
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Affiliation(s)
- LilyAnne Jewett
- Department of Emergency Medicine, University of California at Davis, 2315 Stockton Blvd, PSSB 2100, 95817-2201, Sacramento, CA, USA
| | - Samuel Clarke
- Department of Emergency Medicine, University of California at Davis, 2315 Stockton Blvd, PSSB 2100, 95817-2201, Sacramento, CA, USA
| | - Erin Griffin
- Department of Medical Education and Clinical Sciences, Office of Accreditation, Assessment and Evaluation, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Aaron Danielson
- Department of Emergency Medicine, University of California at Davis, 2315 Stockton Blvd, PSSB 2100, 95817-2201, Sacramento, CA, USA.
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Protpagorn N, Lalitharatne TD, Costi L, Iida F. Vocal pain expression augmentation for a robopatient. Front Robot AI 2023; 10:1122914. [PMID: 37771605 PMCID: PMC10524268 DOI: 10.3389/frobt.2023.1122914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 08/21/2023] [Indexed: 09/30/2023] Open
Abstract
Abdominal palpation is one of the basic but important physical examination methods used by physicians. Visual, auditory, and haptic feedback from the patients are known to be the main sources of feedback they use in the diagnosis. However, learning to interpret this feedback and making accurate diagnosis require several years of training. Many abdominal palpation training simulators have been proposed to date, but very limited attempts have been reported in integrating vocal pain expressions into physical abdominal palpation simulators. Here, we present a vocal pain expression augmentation for a robopatient. The proposed robopatient is capable of providing real-time facial and vocal pain expressions based on the exerted palpation force and position on the abdominal phantom of the robopatient. A pilot study is conducted to test the proposed system, and we show the potential of integrating vocal pain expressions to the robopatient. The platform has also been tested by two clinical experts with prior experience in abdominal palpation. Their evaluations on functionality and suggestions for improvements are presented. We highlight the advantages of the proposed robopatient with real-time vocal and facial pain expressions as a controllable simulator platform for abdominal palpation training studies. Finally, we discuss the limitations of the proposed approach and suggest several future directions for improvements.
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Affiliation(s)
- Namnueng Protpagorn
- Bio Inspired Robotics Laboratory, Department of Engineering, University of Cambridge, Cambridge, United Kingdom
| | - Thilina Dulantha Lalitharatne
- Bio Inspired Robotics Laboratory, Department of Engineering, University of Cambridge, Cambridge, United Kingdom
- Dyson School of Design Engineering, Imperial College London, London, United Kingdom
| | - Leone Costi
- Bio Inspired Robotics Laboratory, Department of Engineering, University of Cambridge, Cambridge, United Kingdom
| | - Fumiya Iida
- Bio Inspired Robotics Laboratory, Department of Engineering, University of Cambridge, Cambridge, United Kingdom
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Juhi A, Pinjar MJ, Marndi G, Hungund BR, Mondal H. Evaluation of Blended Learning Method Versus Traditional Learning Method of Clinical Examination Skills in Physiology Among Undergraduate Medical Students in an Indian Medical College. Cureus 2023; 15:e37886. [PMID: 37214074 PMCID: PMC10199722 DOI: 10.7759/cureus.37886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 05/23/2023] Open
Abstract
Introduction Clinical skills are crucial for medical professionals and are a vital part of a physician's identity. Medical students start learning these skills during their pre-clinical years of study. However, little research has been done on how novice medical students learn to improve these skills. Along with traditional teaching-learning methods, an approach to incorporating e-learning into medical education is through blended learning, which combines traditional classroom instruction with online learning activities. Objective This study aimed to compare the effectiveness of blended learning and traditional learning methods in teaching clinical examination skills to first-year undergraduate medical students by evaluating the objective structured clinical examination (OSCE) test scores. Methodology This was a two-arm prospective cross-over randomized study involving first-year MBBS students. The experimental group (group A) received blended learning, while the control group (group B) received traditional learning for the cardiovascular system examination (phase 1). The groups were then switched for the respiratory system examination (phase 2). An unpaired student t-test was used to compare the mean OSCE scores between the experimental and control groups in each phase, with statistical significance defined as a p-value < 0.05. Results The study involved 25 students in each group during phase 1 and 22 students in each group during phase 2. The experimental group had a mean age of 18.4 (±0.96) years in phase 1 and 18.35 (±1) years in phase 2, while the control group had a mean age of 18.06 (±1.04) years in phase 1 and 18.55 (±0.74) years in phase 2. In phase 1, the experimental group had a higher mean OSCE score (43 {±2.92}) than the control group (26.4 {±2}) (p <0.001). After switching in phase 2, the experimental group (previously the control group) had a higher mean OSCE score (47.82 {±1.68}) than the control group (33.59 {±1.59}) (p <0.001). Conclusion Blended learning is more effective than traditional learning in teaching clinical examination skills to medical undergraduate students. This study suggests that blended learning has the potential to replace the traditional method of learning clinical skills.
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Affiliation(s)
- Ayesha Juhi
- Physiology, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
| | | | - Gujaram Marndi
- Pharmacology, Dharanidhar Medical College and Hospital, Keonjhar, IND
| | | | - Himel Mondal
- Physiology, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
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Flatt E, Brewer P, Racy M, Mushtaq F, Ashworth R, Ali F, Tomlinson J. Can educational video resources improve learning when used to augment traditional teaching of clinical examination? A randomized control trial of novice medical students. BMC MEDICAL EDUCATION 2023; 23:21. [PMID: 36631886 PMCID: PMC9834676 DOI: 10.1186/s12909-022-03974-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Good clinical examination skills can both increase the quality of patient care and reduce its cost. A previous study by our group demonstrated that face-to-face training is the gold standard for teaching these skills. It is unclear if high quality educational videos can augment this teaching. METHODS Forty-two Medical Students naïve to large joint examination were recruited and block randomised to two groups. The control group had face-to-face teaching alone. The intervention group had their teaching augmented with a custom educational video accessed via a web portal. Participants were assessed on their examination of a large joint using a previously standardised assessment tool at baseline and 7 days post intervention. Assessors were blinded to intervention type. RESULTS There was no significant difference in the mean baseline scores. Mean baseline scores were 3.35 (11.2%, SD = 2.2, SE = 0.49) for the face-to-face only group and 2.65 (8.8%, SD = 1.39, SE = 0.31) for the video adjunct group [p = 0.137]. There was a significant difference in the improvement in score after intervention between each group [p = 0.005]. The mean improvement in score was 15.42 (SD = 5.64, SE = 1.29) for the face-to-face only group and 20.68 (SD = 4.33,SE = 0.99) for the video adjunct group. CONCLUSION When used as an adjunct to more traditional face-to-face teaching methods, a custom-made educational video significantly improves the teaching of clinical examination skills and there is a role for these resources in augmenting traditional teaching methods.
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Affiliation(s)
- Ellie Flatt
- Sheffield Teaching Hospitals, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK.
- University of Sheffield, Western Bank, Sheffield, S10 2TN, UK.
| | - Paul Brewer
- Sheffield Teaching Hospitals, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK
- University of Sheffield, Western Bank, Sheffield, S10 2TN, UK
| | - Malek Racy
- Sheffield Teaching Hospitals, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK
| | - Faisal Mushtaq
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK
| | - Rachael Ashworth
- University of Sheffield, Western Bank, Sheffield, S10 2TN, UK
- Hull University Teaching Hospitals, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK
| | - Fazal Ali
- University of Sheffield, Western Bank, Sheffield, S10 2TN, UK
- Chesterfield Royal Hospital, Chesterfield Road, Chesterfield, S44 5BL, Chesterfield, UK
| | - James Tomlinson
- Sheffield Teaching Hospitals, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK
- University of Sheffield, Western Bank, Sheffield, S10 2TN, UK
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Merriott D, Ransley G, Aziz S, Patel K, Rhodes M, Abraham D, Imansouren K, Turton D. Will clinical signs become myth? Developing structured Signs Circuits to improve medical students' exposure to and confidence examining clinical signs. MEDICAL EDUCATION ONLINE 2022; 27:2050064. [PMID: 35388743 PMCID: PMC9004494 DOI: 10.1080/10872981.2022.2050064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Correctly eliciting and interpreting physical examination (PEx) signs contributes to successful diagnosis and is fundamental to patient care. A significant decline in the time spent acquiring these skills by medical students, and the decreased ability to elicit and recognise signs is widely acknowledged. However, organising teaching to counteract this in the busy clinical environment is challenging. We evaluated the prior exposure to clinical signs, and experience of examination teaching among a cohort of final-year medical students. Following this, we assessed the utility of a structured circuit-based approach (Signs Circuits) using hospital inpatients and junior doctors to provide high-yield PEx teaching and overcome these limitations. MATERIALS AND METHODS Qualitative and quantitative survey feedback, including a standardised list of 62 clinical signs, was sought from final-year medical students during their rotations at a teaching hospital in London, UK, before and after the provision of Signs Circuits. RESULTS Prior to the course the 63 students reported limited exposure to even the most common clinical signs. For example, the murmurs of mitral and tricuspid regurgitation and the sound of lung crackles eluded 43%, 87%, and 32%, respectively. From qualitative feedback, the reasons for this included that much of their prior PEx experience had focused on the performance of appropriate examination steps and techniques in patients without pathology. During the course, students were exposed to an average of 4.4 new signs, and left with increased confidence examining and eliciting signs, and a firmer belief in their importance to diagnosis. CONCLUSION Medical students continue to have limited exposure to clinical signs in medical school. This signs-focused approach to PEx teaching is an effective and reproducible way to counter the deficiencies identified in signsexposure.
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Affiliation(s)
- Dominic Merriott
- Intensive Care Registrar, Austin Health, Melbourne, VIC, Australia
| | - George Ransley
- Internal Medicine Trainee, University College London Hospitals NHS Foundation Trust, London, UK
| | - Shadman Aziz
- Emergency Medicine Specialty Trainee, London, UK
| | - Krushna Patel
- Foundation Doctor, King’s College Hospital NHS Foundation Trust, London, UK
| | - Molly Rhodes
- Foundation Doctor, Barts Health NHS Trust, London, UK
| | | | | | - Daniel Turton
- Anaesthetist at Barts Health and Honorary Lecturer at Queen Mary’s University of London, UK
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Alomar AZ. A structured multimodal teaching approach enhancing musculoskeletal physical examination skills among undergraduate medical students. MEDICAL EDUCATION ONLINE 2022; 27:2114134. [PMID: 35993497 PMCID: PMC9466621 DOI: 10.1080/10872981.2022.2114134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 08/05/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
Current evidence indicates that undergraduate medical students display deficits in musculoskeletal physical examination skills (MPES). While various instructional methods are recommended for teaching clinical skills, effective methods for teaching MPES have not been established. This study compared the effectiveness of a multimodal teaching approach incorporating video-based learning, interactive small-group teaching, hands-on practicing, peer-assisted learning, formative assessment, and constructive feedback with traditional bedside teaching in developing undergraduate orthopedic MPES. Participants were 151 fifth-year medical students divided into two groups. One group received multimodal teaching, and the other received traditional bedside teaching. In both groups, the participants learned how to physically examine the knee and shoulder. The primary outcome was objective structured clinical examination (OSCE) scores, while the secondary outcomes included teaching sessions' total durations, facilitator's demonstration time, participants' practice time, and proportion of students with passing checklist scores and global ratings-based assessments for the two teaching approaches. The multimodal teaching group had significantly higher OSCE scores (checklist scores, global ratings, and passing rates; p = 0.02, 0.02, 0.01, respectively) than the comparison group. Individual OSCE component assessments showed significant improvements in the special musculoskeletal physical examination test. The overall duration and amount of participants' hands-on time were significantly longer for the multimodal than for the traditional bedside teaching group (p = 0.01 and 0.01, respectively), and the facilitator's demonstration time was significantly shorter (p = 0.01). The multimodal learner-centered teaching approach evaluated in this study was effective for teaching MPES. It appeared to maximize learner engagement through enhancing interactions and providing increased time to engage in hands-on practice. This teaching approach improved MPES levels, maximized teaching efficiency for scenarios with limited instruction time and resources, and enhanced competency of undergraduate medical students in performing special musculoskeletal physical examinations compared to traditional bedside teaching.
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Affiliation(s)
- Abdulaziz Z. Alomar
- Division of Arthroscopy & Sports Medicine, Department of Orthopaedic Surgery, King Saud University, Riyadh, Saudi Arabia
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Chao YP, Kang CJ, Chuang HH, Hsieh MJ, Chang YC, Kuo TBJ, Yang CCH, Huang CG, Fang TJ, Li HY, Lee LA. Comparison of the effect of 360° versus two-dimensional virtual reality video on history taking and physical examination skills learning among undergraduate medical students: a randomized controlled trial. VIRTUAL REALITY 2022; 27:637-650. [PMID: 35992202 PMCID: PMC9379871 DOI: 10.1007/s10055-022-00664-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 05/25/2022] [Indexed: 05/07/2023]
Abstract
Before caring for patients, video instruction is commonly used for undergraduate medical students, and 360° virtual reality (VR) videos have gained increasing interest in clinical medical education. Therefore, the effect of immersive 360° VR video learning compared with two-dimensional (2D) VR video learning in clinical skills acquisition should be evaluated. This randomized, intervention-controlled clinical trial was aimed to assess whether immersive 360° VR video improves undergraduate medical students' learning effectiveness and reduces the cognitive load in history taking and physical examination (H&P) training. From May 1 2018 to October 30 2018, 64 senior undergraduate medical students in a tertiary academic hospital were randomized to receive a 10-min immersive 360° (360° VR video group; n = 32) or 2D VR instructional video (2D VR video group; n = 32), including essential knowledge and competency of H&P. The demographic characteristics of the two groups were comparable for age, sex, and cognitive style. The total procedure skill score, physical examination score, learner's satisfaction score, and total cognitive load in the 360° VR video group were significantly higher than those in the 2D VR video group (effect sizes [95% confidence interval]: 0.72 [0.21-1.22], 0.63 [0.12-1.13], 0.56 [0.06-1.06], and 0.53 [0.03-1.03], respectively). This study suggested that a10-minute 360° VR video instruction helped undergraduate medical students perform fundamental H&P skills as effectively as 2D VR video. Furthermore, the 360° VR video might result in significantly better procedural metrics of physical examinations with higher learner satisfaction despite the higher cognitive load. Supplementary Information The online version contains supplementary material available at 10.1007/s10055-022-00664-0.
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Affiliation(s)
- Yi-Ping Chao
- Department of Computer Science and Information Engineering, Graduate Institute of Medical Mechatronics, Chang Gung University, 33302 Taoyuan, Taiwan
- Department of Neurology, Chang Gung Memorial Hospital, Linkou Main Branch, 33305 Taoyuan, Taiwan
| | - Chung-Jan Kang
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, College of Medicine, Chang Gung University, 33302 Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Linkou Main Branch, 33305 Taoyuan, Taiwan, Republic of China
| | - Hai-Hua Chuang
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, College of Medicine, Chang Gung University, 33302 Taoyuan, Taiwan
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, 33305 Taiwan
- School of Medicine, College of Life Science, National Tsing Hua University, Hsinchu, 300044 Taiwan
- Department of Industrial Engineering and Management, National Taipei University of Technology, 10608 Taipei, Taiwan
| | - Ming-Ju Hsieh
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, College of Medicine, Chang Gung University, 33302 Taoyuan, Taiwan
- Department of Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, 33305 Taiwan
| | - Yu-Che Chang
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, College of Medicine, Chang Gung University, 33302 Taoyuan, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, 33305 Taiwan
| | - Terry B. J. Kuo
- Institute of Brain Science, National Yang Ming Chiao Tung University, 11221 Taipei, Taiwan
| | - Cheryl C. H. Yang
- Institute of Brain Science, National Yang Ming Chiao Tung University, 11221 Taipei, Taiwan
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Linkou Main Branch, 33305 Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Science, Graduate Institute of Biomedical Sciences, Chang Gung University, 33302 Taoyuan, Taiwan
| | - Tuan-Jen Fang
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, College of Medicine, Chang Gung University, 33302 Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Linkou Main Branch, 33305 Taoyuan, Taiwan, Republic of China
| | - Hsueh-Yu Li
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, College of Medicine, Chang Gung University, 33302 Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Linkou Main Branch, 33305 Taoyuan, Taiwan, Republic of China
| | - Li-Ang Lee
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, College of Medicine, Chang Gung University, 33302 Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Linkou Main Branch, 33305 Taoyuan, Taiwan, Republic of China
- School of Medicine, College of Life Science, National Tsing Hua University, Hsinchu, 300044 Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, 11221 Taipei, Taiwan
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Yu JC, Rashid M, Davila-Cervantes A, Hodgson CS. Difficulties with Learning Musculoskeletal Physical Examination Skills: Student Perspectives and General Lessons Learned for Curricular Design. TEACHING AND LEARNING IN MEDICINE 2022; 34:123-134. [PMID: 34459349 DOI: 10.1080/10401334.2021.1954930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 07/01/2021] [Indexed: 06/13/2023]
Abstract
Phenomenon: The development of foundational clinical skills, such as physical examination, is essential to becoming a competent clinician. Musculoskeletal medicine is often considered a specialized area of practice despite the high prevalence of musculoskeletal conditions in the general population and presenting to general clinical practices. Prior work has shown that medical learners and practicing clinicians have low confidence in these skills but understanding of the student perspective on why these skills are more difficult to acquire is unclear.Approach: Our study was guided by social constructivist learning theory to explore the learner experience and present their perspectives. Qualitative analysis investigated the difference between learning musculoskeletal physical examination versus other body systems, using the voices from 11 semi-structured focus group interviews. Participants included third-year medical students across two academic cohorts at one institution. Our analysis was grounded in the principles of phenomenology and used triangulation and reflexivity to provide rigorous analysis.Findings: Students provided rich and insightful perspectives regarding their experiences in learning musculoskeletal physical examination techniques. Four themes were developed from our data: a) the need for opportunities for both supervised and self-directed practice; b) assessment and competence as motivations for learning; c) the need for a different approach to the content and structure of musculoskeletal medicine and its associated examination techniques; and d) the need for distinct expertise and technical skill from musculoskeletal examination teachers.Insights: This study provides a valuable lens to critically reflect on existing curriculum and pedagogical approaches to musculoskeletal examination skills. Lessons from this study may be applicable to curriculum design in general, especially the teaching of physical examination skills, such as how it is taught and integrated with other content (including anatomy), how much practice is required, who teaches physical examination skills, and what faculty development is needed to standardize teaching. Promoting a learner-centered approach to the teaching and learning of these clinical skills will be beneficial to all stakeholders, especially to our future physicians and their patients.Supplemental data for this article is available online at https://doi.org/10.1080/10401334.2021.1954930 .
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Affiliation(s)
- Jaime C Yu
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Marghalara Rashid
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Andrea Davila-Cervantes
- Office of Lifelong Learning, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Carol S Hodgson
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Heitmann H, Wagner P, Fischer E, Gartmeier M, Schmidt-Graf F. Effectiveness of non-bedside teaching during the COVID-19 pandemic: a quasi-experimental study. BMC MEDICAL EDUCATION 2022; 22:73. [PMID: 35101016 PMCID: PMC8801559 DOI: 10.1186/s12909-022-03141-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/27/2022] [Indexed: 05/30/2023]
Abstract
BACKGROUND The COVID-19 pandemic poses a huge challenge for clinical teaching due to contact restrictions and social distancing. Medical teachers have to balance potential risks and benefits of bedside teaching, especially in course formats intended to foster practical clinical skills. In this context, we aimed to address the question, whether presence-based teaching formats without patient involvement are suitable to teach practical skills. METHODS In this quasi-experimental study, presence-based teaching formats with and without patient contact were retrospectively compared regarding their effects on medical students' theoretical knowledge and practical skills, i.e. the performance and clinical interpretation of the neurological exam. To this end, evaluations from 102 students and their lecturers participating in a neurological bedside teaching course at a German university hospital between October 2020 and April 2021 were obtained. Students were initially randomly assigned to course dates. However, 53 students assigned to courses in November and December 2020, were not able to go bedside due to contact restrictions. These students formed the interventional group and the remaining 49 students the control group. The primary outcome measures were students' overall grading of the course (school grades, 1-6) as well as ratings of knowledge and skills provided by the students themselves and their lecturers on a numerical rating scale (0-10). Comparison between groups was performed using frequentist and Bayesian t-statistics. RESULTS The teaching format without patient contact received a significantly poorer overall grade by the students (p = 0.018). However, improvements in the students' self-ratings of knowledge and skills did not differ between the two formats (all p > 0.05, BF10max = 0.42). Moreover, especially practical skills were even rated significantly better in the group without patient contact by the lecturers (p < 0.001). CONCLUSIONS Teaching formats without patient contact are less well-received by the students. However, they are able to teach practical skills regarding the performance and clinical interpretation of examination techniques. Still, the evaluations obtained might not adequately capture the importance of bedside teaching in preparing future physicians for their practice. Perspectively, hybrid teaching approaches including flipped-classroom concepts hold considerable potential to enhance effectiveness of bedside teaching in the present pandemic situation and in the future.
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Affiliation(s)
- Henrik Heitmann
- Department of Neurology, School of Medicine, Technical University of Munich (TUM), Munich, Germany.
| | - Philipp Wagner
- Department of Neurology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Elisabeth Fischer
- Department of Neurology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Martin Gartmeier
- TUM Medical Education Center, School of Medicine, TUM, Munich, Germany
| | - Friederike Schmidt-Graf
- Department of Neurology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
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Akatsu H, Shiima Y, Gomi H, Hegab AE, Kobayashi G, Naka T, Ogino M. Teaching "medical interview and physical examination" from the very beginning of medical school and using "escape rooms" during the final assessment: achievements and educational impact in Japan. BMC MEDICAL EDUCATION 2022; 22:67. [PMID: 35090459 PMCID: PMC8795952 DOI: 10.1186/s12909-022-03130-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND There is no consensus regarding the best time to teach two fundamental pillars of clinical medicine: medical interview and physical examination. We investigated the impacts of teaching the course "Medical Interview and Physical Examination" in Japan from the very beginning of medical school. In addition, we also evaluated the educational value of using "Escape Rooms", a series of timed, game-based scenarios using simulators, as a part of the final assessment of the course. METHODS At the end of the course, the interview capabilities of 140 first year medical students at International University of Health and Welfare (Japan) were assessed by physicians who acted as simulated patients. Physical examination skills were assessed using the "Escape Room" team task method. Students also self-assessed their confidence in their physical examination skills pre and post "Escape Rooms." A day prior to the final assessment, students completed an anonymous course evaluation. RESULTS The average global rating of the students' medical interview skills using a rating scale from 1 to 6 (1-fail 6-outstanding, no different from practicing junior physician's level) was 4.6. Twenty-two students scored the highest mark of 6. An average of 89% of "Escape Room" teams finished all the physical examination tasks correctly within the allotted time. All teams that could not finish in time completed all tasks correctly when given an additional 3 to 5 min. Students' self-assessed confidence in their physical examination skills increased from 49 to 73 (out of 100) pre and post "Escape Rooms." In the course evaluation questionnaire, 99% of students answered "this course enhanced their motivation" (response rate 89%) and 99% also answered "this course was interesting and useful" (response rate 86%). CONCLUSIONS This descriptive study analyzing both quantitative and qualitative data showed that the course not only achieved the intended objectives of successfully conducting comprehensive medical interview and basic physical examination skills, but also enhanced student motivation. "Escape Rooms", used for the course assessment, in itself enhanced students' self-perceived physical examination skills and had an added educational value.
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Affiliation(s)
- Haruko Akatsu
- International University of Health and Welfare School of Medicine, Narita, Japan.
| | - Yuko Shiima
- International University of Health and Welfare School of Medicine, Narita, Japan
| | - Harumi Gomi
- International University of Health and Welfare School of Medicine, Narita, Japan
| | - Ahmed E Hegab
- International University of Health and Welfare School of Medicine, Narita, Japan
| | - Gen Kobayashi
- International University of Health and Welfare School of Medicine, Narita, Japan
| | - Toshiyuki Naka
- International University of Health and Welfare School of Medicine, Narita, Japan
| | - Mieko Ogino
- International University of Health and Welfare School of Medicine, Narita, Japan
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11
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Hascalovici J, Kohan L, Spektor B, Sobey C, Meroney M, Anitescu M, Barad M, Steinmann A, Vydyanathan A, Wahezi S. The Pain Medicine Fellowship Telehealth Education Collaborative. PAIN MEDICINE 2021; 22:2779-2805. [PMID: 34402913 DOI: 10.1093/pm/pnab251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/10/2021] [Accepted: 08/04/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Jacob Hascalovici
- Multidisciplinary Pain Program.,Saul R. Korey Department of Neurology.,The Arthur S. Abramson Department of Physical Medicine and Rehabilitation.,Department of Anesthesiology.,Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Lynn Kohan
- University of Virginia Department of Anesthesiology
| | - Boris Spektor
- Department of Anesthesiology Emory University School of Medicine
| | | | | | | | | | | | - Amaresh Vydyanathan
- Multidisciplinary Pain Program.,The Arthur S. Abramson Department of Physical Medicine and Rehabilitation.,Department of Anesthesiology.,Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Sayed Wahezi
- Multidisciplinary Pain Program.,The Arthur S. Abramson Department of Physical Medicine and Rehabilitation.,Department of Anesthesiology.,Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
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12
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Mallinson T. An exploratory study into the teaching of clinical examination skills in advanced practice. ACTA ACUST UNITED AC 2021; 30:712-720. [PMID: 34170723 DOI: 10.12968/bjon.2021.30.12.712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Clinical examination skills are vital for the accurate assessment and diagnosis of patients. These skills also allow clinicians to differentiate between pathology requiring investigation or treatment and normal anatomy or physiology. This allows clinicians to avoid unnecessary tests and to be able to reassure a patient that their symptoms do not require treatment. However, an incomplete or faulty clinical examination can lead to missed diagnoses and patient harm. Although comprehensive clinical examination skills training is provided in the undergraduate curriculum of medical schools in the UK, little is known in relation to the teaching provided for nurses and allied health professions working in advanced practice roles. This survey sought to explore this phenomenon and uncover clinicians' experiences with regard to being taught a selection of specific clinical examination skills in theory and in practice, those skills being the core system examinations (respiratory, cardiovascular and peripheral vascular, abdominal, central and peripheral nervous systems) and a number of focused examinations (digital rectal and examination, thyroid, breast and genital examination for males and females). The findings demonstrate a concerning variability of educational experiences and a lack of educational coverage of some of the basic clinical examination skills in both theoretical and practical terms. These findings provide an insight into areas of future higher education curricula development as well as workplace mentoring and learning.
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Affiliation(s)
- Tom Mallinson
- Prehospital Doctor, British Association for Immediate Care Scotland, Aberuthven, Auchterarder
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13
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Brewer PE, Racy M, Hampton M, Mushtaq F, Tomlinson JE, Ali FM. A three-arm single blind randomised control trial of naïve medical students performing a shoulder joint clinical examination. BMC MEDICAL EDUCATION 2021; 21:390. [PMID: 34284771 PMCID: PMC8293563 DOI: 10.1186/s12909-021-02822-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 05/28/2021] [Indexed: 05/11/2023]
Abstract
BACKGROUND Technological advances have previously been hailed as a new dawn in Higher Education, with the advent of 'massive open online courses' (MOOCs) and online learning. Virtual platforms have potential advantages such as accessibility and availability but simply transferring educational material to the online environment may not ensure high quality learning. Clinical examination is a fundamental principle of medical assessment, and this study aimed to assess the role of technology in teaching these skills. AIMS/OBJECTIVES To determine whether three teaching modalities were of equal efficacy in teaching examination of the shoulder joint to naïve medical students. METHODS Sixty-seven pre-clinical medical students naïve to large joint examination were recruited. Participants completed a learning style questionnaire and were then block randomised to three study: textbook study, face-to-face seminar, or video tutorial via online platform. The same examination technique was taught in all groups, with the intervention being the method of delivery All second year students were eligible for inclusion. The single exclusion criteria was previous exposure to clinical examination teaching. Students were assessed using a standardised scoring system at baseline (pre-intervention), and days 5 and 19 post-intervention (maximum score 30). Assessors were blinded to group allocation. The primary outcome was assessment score at day 5 post intervention. RESULTS There was no difference between the three groups at baseline assessment (mean scores 2.4 for textbook, 2.8 for face-to-face, and 3.1 for video; p = 0.267). Mean post-intervention scores were 16.5 textbook, 25.5 face-to-face, and 22.4 video (p < 0.001, η2 = .449). There was no change between day 5 and day 19 post-intervention assessment scores in any group (p = 0.373), Preferred learning style did not affect scores (p = 0.543). CONCLUSION Face-to-face teaching was the most effective method for teaching clinical examination of the shoulder. Technology can potentially increase accessibility and remove geographic barriers, but is not as effective if teaching techniques are simply mirrored in an online format. Online platforms allow in depth data analysis of how learners interact with educational material and this may have value in improving the design of online educational materials, and is a potential area for further research.
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Affiliation(s)
- P E Brewer
- Sheffield Teaching Hospitals, Northern General Hospital, Herries Road, Sheffield, S57AU, UK.
- University of Sheffield, Western Bank, Sheffield, S10 2TN, UK.
| | - M Racy
- Sheffield Teaching Hospitals, Northern General Hospital, Herries Road, Sheffield, S57AU, UK
| | - M Hampton
- Sheffield Teaching Hospitals, Northern General Hospital, Herries Road, Sheffield, S57AU, UK
| | - F Mushtaq
- University of Leeds, Leeds, Ls2 9JT, UK
| | - J E Tomlinson
- Sheffield Teaching Hospitals, Northern General Hospital, Herries Road, Sheffield, S57AU, UK
- University of Sheffield, Western Bank, Sheffield, S10 2TN, UK
| | - F M Ali
- University of Sheffield, Western Bank, Sheffield, S10 2TN, UK
- Chesterfield Royal Hospital, Derbyshire, Chesterfield, S44 5BL, UK
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14
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Russo S, Berg K, Davis J, Davis R, Riesenberg LA, Morgan C, Chambers L, Berg D. Incoming Interns Recognize Inadequate Physical Examination as a Cause of Patient Harm. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520928993. [PMID: 32577530 PMCID: PMC7288807 DOI: 10.1177/2382120520928993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 05/04/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION As providers of a large portion of the care delivered at academic health centers, medical trainees have a unique perspective on medical error. Despite data suggesting that errors in physical examination (PE) can lead to adverse patient events, we are not aware of previous studies exploring medical trainee perceptions of the relationship between patient harm and inadequate PE. We investigated whether first-year residents at a large tertiary care academic medical center perceive inadequate PE as a cause of adverse patient events. METHODS As part of a larger survey given to incoming interns at Thomas Jefferson University Hospital orientation (2014-2018), the authors examined the perceptions of inadequate PE and adverse patient events. We also examined other details related to PE educational experiences and self-reported PE proficiency. The survey was developed a priori by the authors and assessed for face validity by expert faculty. RESULTS Ninety-eight percent of respondents (695/706) reported that inadequate PE leads to adverse patient events. Seventy percent (492/706) believe that inadequate PE causes adverse events in up to 10% of all patient encounters, and 30% (214/706) reported that inadequate PE causes adverse events in greater than 10% of patient encounters. Forty-five percent of surveyed interns (319/715) had witnessed a patient safety issue as a result of an inadequate PE. Only 2% of surveyed interns (11/706) did not think patients experience adverse events because of inadequate PEs. Ninety percent of surveyed interns (643/712) reported feeling proficient in performing PE. From 2015 to 2018, 80% (486/604) indicated that they received "just enough" PE education. CONCLUSION Nearly all incoming interns surveyed at our institution believe that inadequate PE leads to adverse patient events, and 45% have witnessed an adverse patient event due to inadequate PE. We urge clinicians, educators, and health care administrators to consider enhanced PE skills training as an important and viable approach to medical error reduction, and as such, we propose a 5-pronged intervention for improvement, including a redesign of PE curricula, development of checklist-based assessment methods, ongoing skills training and assessment of physicians-in-practice, rigorous study of PE maneuvers, and research into whether enhanced PE skills improve patient outcomes.
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Affiliation(s)
- Stefani Russo
- Sidney Kimmel Medical College, Thomas
Jefferson University, Philadelphia, PA, USA
| | - Katherine Berg
- Sidney Kimmel Medical College, Thomas
Jefferson University, Philadelphia, PA, USA
| | - Joshua Davis
- Department of Emergency Medicine, Penn
State Hershey Medical Center, Hershey, PA, USA
| | - Robyn Davis
- Department of Anesthesiology and
Perioperative Medicine, The University of Alabama at Birmingham, Birmingham, AL,
USA
| | - Lee Ann Riesenberg
- Department of Anesthesiology and
Perioperative Medicine, The University of Alabama at Birmingham, Birmingham, AL,
USA
| | - Charity Morgan
- Department of Biostatistics, School of
Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lucas Chambers
- University of Virginia School of
Medicine, Charlottesville, VA, USA
| | - Dale Berg
- Sidney Kimmel Medical College, Thomas
Jefferson University, Philadelphia, PA, USA
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15
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Huang SS, Huang CC, Yang YY, Wang SJ, Shulruf B, Chen CH. Dreyfus scale-based feedback increases the medical student's satisfaction with the complex cluster part of the interviewing and physical examination course and skills' readiness in Taiwan. JOURNAL OF EDUCATIONAL EVALUATION FOR HEALTH PROFESSIONS 2019; 16:30. [PMID: 31614407 PMCID: PMC6848653 DOI: 10.3352/jeehp.2019.16.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/11/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE Different from the basic core part of the clinical interviewing and physical examination (PE) skills course in basic, head-to-toe, and thorax systems, learners need structural feedback for the development of the complex skills in cluster part including abdominal, neuromuscular and musculoskeletal systems. It aimed to evaluate the effects of replacing Dreyfus scale, which having elements of continuous professional development, with Likert scale in the feedback in cluster part of training in Taiwan. METHODS Instructors and final-year medical students of class 2015-2016 comprised the regular cohort, whereas those of class 2017-2018 formed the intervention cohort. In the intervention cohort, Dreyfus scale-based feedback rather than Likert scale based feedback was used in the cluster part of the course in National Yang-Ming university, Taiwan. RESULTS Among the regular cohort, poor pre-trained standardized patients (SPs) rated class climate, low grouped students satisfaction with the instructors and course, and low grouped student self-assessed readiness were noted in the cluster part than those in the core part. In comparison with regular cohort, greater improvement of post-cluster part end-of-course group objective structured clinical examination (GOSCE) scores was noted in intervention cohort. In other word, the implementation of Dreyfus scale-based feedback in the cluster part improved the deficit in this part of the course among the intervention cohort. CONCLUSION The implementation of Dreyfus scale-based feedback helped instructors to create a good class climate in the cluster parts of clinical interviewing plus PE skills course in our study. Simultaneously, this new intervention achieved the goal of medical students competency in interviewing, PE and self-directed learning (SDL) skills.
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Affiliation(s)
- Shiau-Shian Huang
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
- Bali Psychiatric Center, Ministry of Health and Welfare, Taipei, Taiwan
| | - Chia-Chang Huang
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ying-Ying Yang
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shuu-Jiun Wang
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Boaz Shulruf
- Office of Medical Education, University of New South Wales Australia, Sydney, Australia
| | - Chen-Huan Chen
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
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