A sampling strategy for promoting and assessing medical student retention of physical examination skills

Assessment and recency drive skill acquisition

BACKGROUND

The assessment of medical students' clinical skill acquisition is variable and is driven by differences in curricula and health services requirements. This project aimed to ascertain whether different assessment models impact on students' performance of as intravenous (i.v.) cannulation. Recency of practice was also explored as a factor influencing performance.

METHODS

A total of 137 students in the first clinical year (years 2 or 3 of a 4-year course) of their medical degree, from four regional clinical schools, participated in a multiple-station mock objective structured clinical examination (MOSCE). Intravenous cannulation was one of the stations examined. Fifty-nine students came from a model that required the assessment of i.v. proficiency during their clinical year (model 1). Seventy-eight students came from a model that required no assessment of i.v. proficiency (model 2). Students reported their most recent clinical i.v. cannulation experience relative to the MOSCE.

RESULTS

The MOSCE pass rate of 73% for students in model 1 was significantly higher than the corresponding MOSCE pass rate of 45% for students in model 2. There was a highly significant association between assessment model and MOSCE pass/fail rate. The assessment model was also highly associated with recency of practice. The assessment of medical students' clinical skill acquisition is variable CONCLUSIONS: The results support an assessment model that promotes the continuing clinical practice of i.v. cannulation. Integration of this model will require innovative approaches by staff and collaboration with affiliated organisations.

Effects of a new parallel primary healthcare centre and on-campus training programme on history taking, physical examination skills and medical students' preparedness: a prospective comparative study in Taiwan

OBJECTIVES

The primary healthcarecentre (PHCC) is the first place that medical students experience patient contact. Usually, medical students are frustrated by a lack of proper skills training for on-campus history taking (HT), physical examination (PE) and self-directed learning (SDL) to prepare for their PHCC and inhospital patient contact. For pre-clerks, this study aims to compare the effectiveness of PHCC training and PHCC training in combination with on-campus HT and PE training modules (PHCC+on-campus) on their clerkship preparedness.

DESIGN

This comparative study utilised prospective, consecutive, end of pre-clerkship group objective structured clinical examination (GOSCE), beginning of clerkship OSCE and self-administered Preparation for Hospital Practice Questionnaire (PHPQ).

SETTING/PARTICIPANTS

128 pre-clinical clerk volunteers (64 each year) receiving PHCC training (7 week PHCCtraining in addition to 7 week assignment based group learning, academic year 2014, controls) and PHCC training in combination with on-campus module training (academic year 2015, 7 week PHCCtraining in addition to 7 week on-campus sessions) were sequentially assessed before the module (week 1), at the end of the module (week 14) and at the beginning of clerkship (week 25).

RESULTS

For overall HT and PE skills, both PHCC and PHCC+on-campus module trained pre-clerks performed better on OSCE than GOSCE. Additionally, the improvement was accompanied by higher self-reported PHPQ scores in 'confidence/coping' and 'SDL' domains. At the end of the pre-clerkship and the beginning of the clerkship stages, the degree of improvement in preparedness in 'confidence/coping' and 'SDL' domains was higher for those in the PHCC+on-campus group than for those in the PHCC group. Among the PHCC+on-campus module participants, a positive association was observed between high mean PHPQ-SDL scores and high OSCE scores.

CONCLUSIONS

Our study suggests that the PHCC+on-campus module, which is paired faculty led and pre-trained dyad student assisted, is effective in developing a preclinical clerk's HT and PE skills and intensifying SDL/patient management abilities to prepare for hospital practice in clerkship.

An innovative pediatric chest tube insertion task trainer simulation: a technical report and pilot study

INTRODUCTION

Iatrogenic complications associated with chest tube insertion (CTI) could be related to the gaps in the procedural fidelity of the current CTI training models and their insufficiency to support training of procedural mastery. A CTI bench model simulation developed with reference to preexisting curriculum increases trainees' exposure and practice of this clinical skill. Newly developed training models need to be recognized by trainees as a usable learning device. In this report, we describe the development of a novel CTI model, based on curriculum, and survey its usability as a training model among pediatric trainees.

METHODS

Based on the acute trauma life support curriculum for CTI and expert interview, a pediatric CTI task trainer (PCTITT) model was developed, piloted, and then implemented for usability by volunteer pediatric residents and pediatric emergency fellows in 2 procedural training courses. Participants responded to 11 questions designed to capture self-reported attitudes toward the usability of the PCTITT as a training model for CTI. Results were obtained using a subjective 5-point Likert scale.

RESULTS

Of the 32 participants, we achieved a response rate of 75%. Of these respondents, 92% had some kind of CTI hands-on training in the past, and 50% had experience with a real patient. Of these respondents, 91% recommended this model for training, and 80% stated that this model was superior to previous models.

CONCLUSIONS

A PCTITT is an easy to create and feasible bench top task trainer to teach CTI skills, which integrates with other simulations currently in use the process of teaching CTI. Trainees recognized it as usable and superior to previous models. Future work needs to focus on the improvement of model fidelity, skills transferability, and tool validation.

Performance of physical examination skills in medical students during diagnostic medicine course in a University Hospital of Northwest China

This study was conducted to evaluate the performance of physical examination (PE) skills during our diagnostic medicine course and analyze the characteristics of the data collected to provide information for practical guidance to improve the quality of teaching. Seventy-two fourth-year medical students were enrolled in the study. All received an assessment of PE skills after receiving a 17-week formal training course and systematic teaching. Their performance was evaluated and recorded in detail using a checklist, which included 5 aspects of PE skills: examination techniques, communication and care skills, content items, appropriateness of examination sequence, and time taken. Error frequency and type were designated as the assessment parameters in the survey. The results showed that the distribution and the percentage in examination errors between male and female students and among the different body parts examined were significantly different (p<0.001). The average error frequency per student in females (0.875) was lower than in males (1.375) although the difference was not statistically significant (p = 0.167). The average error frequency per student in cardiac (1.267) and pulmonary (1.389) examinations was higher than in abdominal (0.867) and head, neck and nervous system examinations (0.917). Female students had a lower average error frequency than males in cardiac examinations (p = 0.041). Additionally, error in examination techniques was the highest type of error among the 5 aspects of PE skills irrespective of participant gender and assessment content (p<0.001). These data suggest that PE skills in cardiac and pulmonary examinations and examination techniques may be included in the main focus of improving the teaching of diagnostics in these medical students.

A hypothesis-driven physical examination learning and assessment procedure for medical students: initial validity evidence

CONTEXT

Diagnostic accuracy is maximised by having clinical signs and diagnostic hypotheses in mind during the physical examination (PE). This diagnostic reasoning approach contrasts with the rote, hypothesis-free screening PE learned by many medical students. A hypothesis-driven PE (HDPE) learning and assessment procedure was developed to provide targeted practice and assessment in anticipating, eliciting and interpreting critical aspects of the PE in the context of diagnostic challenges.

OBJECTIVES

This study was designed to obtain initial content validity evidence, performance and reliability estimates, and impact data for the HDPE procedure.

METHODS

Nineteen clinical scenarios were developed, covering 160 PE manoeuvres. A total of 66 Year 3 medical students prepared for and encountered three clinical scenarios during required formative assessments. For each case, students listed anticipated positive PE findings for two plausible diagnoses before examining the patient; examined a standardised patient (SP) simulating one of the diagnoses; received immediate feedback from the SP, and documented their findings and working diagnosis. The same students later encountered some of the scenarios during their Year 4 clinical skills examination.

RESULTS

On average, Year 3 students anticipated 65% of the positive findings, correctly performed 88% of the PE manoeuvres and documented 61% of the findings. Year 4 students anticipated and elicited fewer findings overall, but achieved proportionally more discriminating findings, thereby more efficiently achieving a diagnostic accuracy equivalent to that of students in Year 3. Year 4 students performed better on cases on which they had received feedback as Year 3 students. Twelve cases would provide a reliability of 0.80, based on discriminating checklist items only.

CONCLUSIONS

The HDPE provided medical students with a thoughtful, deliberate approach to learning and assessing PE skills in a valid and reliable manner.

Perspective: moving students beyond an organ-based approach when teaching medical interviewing and physical examination skills

Medical interviewing and physical examination skills are core pillars of clinical medicine. Though nearly all U.S. medical students participate in preclinical courses designed to teach these skills, medical school faculty often comment that students' abilities remain limited on entering their clinical clerkships. The reason for this contention is not clear.The author briefly describes the current preclinical curricula at most medical schools that are designed to teach patient interviewing and examination. An organ-based curriculum is commonly employed, although the limitations of such an approach readily become apparent. For example, many hospitalized patients do not suffer from single-organ illnesses, but rather from infections or metabolic derangements, which cause numerous abnormalities to several body systems. Furthermore, clinical reasoning skills are rarely taught in such preclinical courses, though these abilities form the foundation for effective doctoring. These findings suggest an opportunity for content development surrounding patient interviewing and examination. The author proposes an educational approach that depicts how the confluence of both content knowledge skills and clinical reasoning skills can work synergistically to enhance preclinical teaching of the medical interview and physical examination.