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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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Walker R, Phieffer LS, Bishop JY. Four Successive Years of Trauma-Based Objective Structured Clinical Evaluations: What Have We Learned? JOURNAL OF SURGICAL EDUCATION 2016; 73:648-654. [PMID: 27156387 DOI: 10.1016/j.jsurg.2016.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/04/2016] [Accepted: 03/02/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE We studied 4 years of data from our objective structured clinical examination (OSCE) to determine whether residents improved skills in the trauma physical examination (PE). Our hypothesis was that residents would improve with each year of training, and that resident scores would also improve over time, with each year of OSCE testing. DESIGN We developed 2 polytrauma scenarios and alternated yearly. Residents were graded on PE, history taking, and professionalism. Scenarios simulated trauma cases residents could encounter during training. We compared each year for any significant (p < 0.05) changes overall and between postgraduate years. SETTING The Ohio State University Wexner Medical Center. PARTICIPANTS Orthopedic faculty and residents. RESULTS Across years 2010 to 2013, we saw no significant improvement in PE skills. History-taking skills trended upwards, but this was not significant, and communication skills significantly improved. CONCLUSIONS We expected after instituting a trauma OSCE that we would see an improvement in residents' PE skills, which we did not. We observed an overall improvement in ability to interact and communicate with patients and ask appropriate questions.
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Affiliation(s)
- Robert Walker
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Laura S Phieffer
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Julie Y Bishop
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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LaRochelle JS, Dong T, Durning SJ. Preclerkship Assessment of Clinical Skills and Clinical Reasoning: The Longitudinal Impact on Student Performance. Mil Med 2015; 180:43-6. [DOI: 10.7205/milmed-d-14-00566] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
ABSTRACT
Purpose: Many medical schools across the United States are undergoing curriculum reform designed, in part, to integrate basic sciences and clinical skills. Evidence has suggested that preclerkship courses in clinical skills and clinical reasoning are predictive of student performance on the clerkship. We hypothesized that a combination of outcome measures from preclerkship clinical skills and clinical reasoning courses (Objective Structured Clinical Examination scores, preceptor evaluations, National Board of Medical Examiners subject examination scores, and small group participation grades) would be correlated to performance in internship (program director [PD] evaluation form at end of first postgraduate year). Methods: Outcome measures from preclerkship clinical skills and clinical reasoning courses and PD evaluation forms from 514 medical students graduating between 2009 and 2011 were analyzed in a multiple linear regression model. Results: Preclerkship clinical skills and clinical reasoning outcome measures were significant contributors to the linear regression model and were able to explain 13.9% of the variance in expertise and 7.6% of the variance in professionalism as measured by the PD evaluation form. Conclusion: Clinical skills and clinical reasoning courses during the preclerkship period explained a significant amount of performance at the graduate medical education level. Our data suggest that these courses provide valuable information regarding student abilities in internship. Early recognition of struggling students may provide an opportunity to break a cycle of poor performance that can persist into residency training.
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Affiliation(s)
- Jeffrey S. LaRochelle
- Department of Medicine, F. Edward Hébert Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Ting Dong
- Department of Medicine, F. Edward Hébert Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Steven J. Durning
- Department of Medicine, F. Edward Hébert Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
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Sinha P, Yoo ADH. Back to bayesics. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:1096. [PMID: 25072457 DOI: 10.1097/acm.0000000000000385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Pranay Sinha
- Fourth-year student, University of Virginia School of Medicine, Charlottesville, Virginia; . Fourth-year student, University of Virginia School of Medicine, Charlottesville, Virginia
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Uchida T, Farnan JM, Schwartz JE, Heiman HL. Teaching the physical examination: a longitudinal strategy for tomorrow's physicians. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:373-5. [PMID: 24448055 DOI: 10.1097/acm.0000000000000136] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The physical examination is an essential clinical skill. The traditional approach to teaching the physical exam has involved a comprehensive "head-to-toe" checklist, which is often used to assess students before they begin their clinical clerkships. This method has been criticized for its lack of clinical context and for promoting rote memorization without critical thinking. In response to these concerns, Gowda and colleagues surveyed a national sample of clinical skills educators in order to develop a consensus "core" physical exam, which they report in this issue. The core physical exam is intended to be performed for every patient admitted by students during their medicine clerkships and to be supplemented by symptom-driven "clusters" of additional history and physical exam maneuvers.In this commentary, the authors review the strengths and limitations of this Core + Clusters technique as well as the head-to-toe approach. They propose that the head-to-toe still has a place in medical education, particularly for beginning students with little knowledge of pathophysiology and for patients with vague or multiple symptoms. The authors suggest that the ideal curriculum would include teaching both the head-to-toe and the Core + Clusters exams in sequence. This iterative approach to physical exam teaching would allow a student to assess a patient in a comprehensive manner while incorporating more clinical reasoning as further medical knowledge is acquired.
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Affiliation(s)
- Toshiko Uchida
- Dr. Uchida is director of clinical skills education, Clinical Education Center, Augusta Webster Office of Medical Education, and assistant professor, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Dr. Farnan is director of clinical skills education, medical director of the clinical performance center, and assistant professor, Section of Hospital Medicine, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois. Dr. Schwartz is statewide course director, Introduction to Clinical Medicine II, Indiana University School of Medicine, and assistant professor of clinical medicine, Division of Hematology-Oncology, Department of Medicine, Indiana University, Indianapolis, Indiana. Dr. Heiman is medical director, Clinical Education Center, clinical medicine element chair, Augusta Webster Office of Medical Education, and assistant professor, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Gowda D, Blatt B, Fink MJ, Kosowicz LY, Baecker A, Silvestri RC. A core physical exam for medical students: results of a national survey. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:436-42. [PMID: 24448049 DOI: 10.1097/acm.0000000000000137] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE Medical students are traditionally taught the physical exam as a comprehensive battery of maneuvers, yet they express uncertainty about which maneuvers are "core" and should be performed routinely on patients and which ones should be performed only when clinically indicated. The authors sought to determine whether educator consensus existed on the concept and the specifics of a core physical exam for students. METHOD The authors developed a 45-maneuver core physical exam to be performed by a medicine clerkship student on every newly admitted patient, with the expectation that it would be supplemented by clinically indicated additional maneuvers. From 2011 to 2012 they sent surveys to physical diagnosis course directors (PDCDs) and internal medicine clerkship directors (IMCDs) from all 132 U.S. allopathic medical schools to determine the extent of their agreement with the proposed 45 maneuvers and their opinions about the concept of a core exam. RESULTS Seventy-one percent (94/132) of PDCDs and 63% (83/132) of IMCDs responded to the survey. In total, 84% (111/132) of all schools surveyed were represented by either their PDCD or IMCD. Of the 45 proposed maneuvers, 37 were deemed "core" by a majority of respondents. The majority of IMCDs preferred a slightly leaner 37-maneuver core exam than the majority of PDCDs, who voted for 41 maneuvers. CONCLUSIONS Among PDCDs and IMCDs, there was openness to teaching medical students a streamlined core physical exam to which other maneuvers are added as clinically indicated. These educators closely agreed on the maneuvers this core exam should include.
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Affiliation(s)
- Deepthiman Gowda
- Dr. Gowda is assistant professor of medicine, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, New York. Dr. Blatt is professor of medicine, Department of Medicine, George Washington University School of Medicine, Washington, DC. Dr. Fink is assistant professor of medicine, Program in Family Medicine, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, New York. Dr. Kosowicz is associate professor of medicine, Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut. Ms. Baecker is a PhD candidate in epidemiology, University of California at Los Angeles, Los Angeles, California. At the time of this study, Ms. Baecker was an MPH candidate, Columbia University Mailman School of Public Health, New York, New York. Dr. Silvestri is assistant professor of medicine, Department of Medicine, Harvard Medical School, and physician, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Haring CM, van der Meer JWM, Postma CT. A core physical examination in internal medicine: what should students do and how about their supervisors? MEDICAL TEACHER 2013; 35:e1472-7. [PMID: 23570566 DOI: 10.3109/0142159x.2013.778396] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND Performance of a focused physical examination will induce a high cognitive load for medical students in the early phase of the clinical clerkships. AIM To come to a workable and clinically applicable standard physical examination for medical students to be used in every new patient in the daily clinical practice of internal medicine. METHOD A questionnaire held among physicians that supervise students during the clerkship of internal medicine in one Dutch training region. RESULTS Of the complete list of physical examination 55 items were considered to be an integral part of the standard general physical examination for medical students. Most emphasized were elements of the physical examination aimed at general parameters, thorax and abdomen, vascular status, lymph nodes, spinal column, skin and some parts of the neurological examination. The standard physical examinations performed by supervisors themselves contain fewer items than they expected from the students. The expectations a supervisor has towards the student correlates with the frequency with which they apply the various components in their own physical examination. CONCLUSION This study provides us with a 'core' physical examination for medical students that can be applied in the early phase of the clinical clerkships.
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Bishop JY, Awan HM, Rowley DM, Nagel RW. Development and validation of a musculoskeletal physical examination decision-making test for medical students. JOURNAL OF SURGICAL EDUCATION 2013; 70:451-460. [PMID: 23725932 DOI: 10.1016/j.jsurg.2013.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 02/13/2013] [Accepted: 03/24/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Despite a renewed emphasis among educators, musculoskeletal education is still lacking in medical school and residency training programs. We created a musculoskeletal multiple-choice physical examination decision-making test to assess competency and physical examination knowledge of our trainees. DESIGN We developed a 20-question test in musculoskeletal physical examination decision-making test with content that most medical students and orthopedic residents should know. All questions were reviewed by ratings of US orthopedic chairmen. It was administered to postgraduate year 2 to 5 orthopedic residents and 2 groups of medical students: 1 group immediately after their 3-week musculoskeletal course and the other 1 year after the musculoskeletal course completion. We hypothesized that residents would score highest, medical students 1 year post-musculoskeletal training lowest, and students immediately post-musculoskeletal training midrange. We administered an established cognitive knowledge test to compare student knowledge base as we expected the scores to correlate. SETTING Academic medical center in the Midwestern United States. PARTICIPANTS Orthopedic residents, chairmen, and medical students. RESULTS Fifty-four orthopedic chairmen (54 of 110 or 49%) responded to our survey, rating a mean overall question importance of 7.12 (0 = Not Important; 5 = Important; 10 = Very Important). Mean physical examination decision-making scores were 89% for residents, 77% for immediate post-musculoskeletal trained medical students, and 59% 1 year post-musculoskeletal trained medical students (F = 42.07, p<0.001). The physical examination decision-making test was found to be internally consistent (Kuder-Richardson Formula 20 = 0.69). The musculoskeletal cognitive knowledge test was 78% for immediate post-musculoskeletal trained students and 71% for the 1 year post-musculoskeletal trained students. The student physical examination and cognitive knowledge scores were correlated (r = 0.54, p<0.001), but were not significantly different for either class. CONCLUSIONS The physical examination decision-making test was found to be internally consistent in exposing the deficiencies of musculoskeletal education skills of our medical students and differentiated between ability levels in musculoskeletal physical examination decision-making (residents vs recently instructed musculoskeletal students vs 1 year post-musculoskeletal instruction).
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Affiliation(s)
- Julie Y Bishop
- Department of Orthopaedics, Ohio State University Medical Center, Columbus, Ohio 43221, USA.
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Guiot AB, Baker RC, Dewitt TG. When and How Pediatric History and Physical Diagnosis Are Taught in Medical School: A Survey of Pediatric Clerkship Directors. Hosp Pediatr 2013; 3:139-43. [PMID: 24340414 DOI: 10.1542/hpeds.2012-0058] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Backround:
History and physical diagnosis skills (HPDS) are required curriculum in medical schools (MS) with pediatric HPDS (PHPDS) necessitating instruction in addition to adult HPDS. Perceived deficiencies in these skills on the pediatric clerkship prompted investigation of when and how other MS taught PHPDS. The concern of whether medical students are adequately taught PHPDS needed to be addressed.
Methods:
With the use of the Council on Medical Student Education in Pediatrics listserv, pediatric clerkship directors from 129 US, 15 Canadian, and 2 Puerto Rican MS were contacted via e-mail to complete an anonymous online questionnaire, focused on MS demographics, PHPDS timing, teaching methods, and barriers.
Results:
Seventy-two (49%) of 146 MS responded to the survey; 18.1% of MS responders did not offer PHPDS in the first 2 years. Methodologies used to educate students included didactic lectures, physician shadowing, hands-on with patients, pairing with preceptor, instructional video, and examination of newborns. Each teaching method had <3 hours dedicated to medical students during their first 2 years at a majority of the MS. Of the responders, 85.1% concurred that medical students should be exposed to PHPDS before starting the clerkship. Barriers to providing PHPDS included MS time allotment, preceptor availability, and total number of students to accommodate.
Conclusions:
This study demonstrated striking variability among MS in how and when medical students were taught PHPDS. Clarification of the role of PHPDS instruction in preclinical years and standardized effective approaches to PHPDS instruction are both needed so that MS curriculum optimizes physician training.
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Affiliation(s)
- Amy B.L. Guiot
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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Duvivier RJ, van Geel K, van Dalen J, Scherpbier AJJA, van der Vleuten CPM. Learning physical examination skills outside timetabled training sessions: what happens and why? ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2012; 17:339-55. [PMID: 21710301 PMCID: PMC3378843 DOI: 10.1007/s10459-011-9312-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 06/16/2011] [Indexed: 05/10/2023]
Abstract
Lack of published studies on students' practice behaviour of physical examination skills outside timetabled training sessions inspired this study into what activities medical students undertake to improve their skills and factors influencing this. Six focus groups of a total of 52 students from Years 1-3 using a pre-established interview guide. Interviews were recorded, transcribed and analyzed using qualitative methods. The interview guide was based on questionnaire results; overall response rate for Years 1-3 was 90% (n = 875). Students report a variety of activities to improve their physical examination skills. On average, students devote 20% of self-study time to skill training with Year 1 students practising significantly more than Year 3 students. Practice patterns shift from just-in-time learning to a longitudinal selfdirected approach. Factors influencing this change are assessment methods and simulated/real patients. Learning resources used include textbooks, examination guidelines, scientific articles, the Internet, videos/DVDs and scoring forms from previous OSCEs. Practising skills on fellow students happens at university rooms or at home. Also family and friends were mentioned to help. Simulated/real patients stimulated students to practise of physical examination skills, initially causing confusion and anxiety about skill performance but leading to increased feelings of competence. Difficult or enjoyable skills stimulate students to practise. The strategies students adopt to master physical examination skills outside timetabled training sessions are self-directed. OSCE assessment does have influence, but learning takes place also when there is no upcoming assessment. Simulated and real patients provide strong incentives to work on skills. Early patient contacts make students feel more prepared for clinical practice.
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Affiliation(s)
- Robbert J Duvivier
- Skillslab, Faculty of Health Medicine and Life Sciences, Maastricht University, The Netherlands.
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Beran MC, Awan H, Rowley D, Samora JB, Griesser MJ, Bishop JY. Assessment of musculoskeletal physical examination skills and attitudes of orthopaedic residents. J Bone Joint Surg Am 2012; 94:e36. [PMID: 22438009 DOI: 10.2106/jbjs.k.00518] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although the musculoskeletal physical examination is an essential part of patient encounters, we believe that it is underemphasized in residency education and that residents' physical examination skills may be lacking. We sought to assess attitudes regarding teaching of the physical examination in orthopaedic residencies, to assess physical examination knowledge and skills among residents, and to develop a method to track the skill level of residents in order to improve our physical examination curriculum. METHODS We created a thirty-question multiple-choice musculoskeletal physical examination test and administered it to our residents. We created a five-question survey assessing attitudes toward physical examination teaching in orthopaedic residencies and distributed it to U.S. orthopaedic department chairs We developed an Objective Structured Clinical Examination (OSCE), in which standardized patients enact four clinical scenarios, to observe and assess physical examination skills. RESULTS The mean score on the multiple-choice physical examination test was 76% despite the fact that our residents consistently scored above 90% on the Orthopaedic In-Training Examination. Department chairs and residents agreed that, although learning to perform the physical examination is important, there is not enough time in the clinical setting to observe and critique a resident's patient examination. The overall score of our residents on the OSCE was 66%. CONCLUSIONS We have exposed a deficiency in the physical examination knowledge and skills of our residents. Although the musculoskeletal physical examination is a vital practice component, our data indicate that it is likely underemphasized in training. Clinic time alone is likely insufficient for the teaching and learning of the musculoskeletal physical examination.
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Affiliation(s)
- Matthew C Beran
- Department of Orthopaedics, The Ohio State University, 2050 Kenny Road, Suite 3100, Columbus, OH 43221, USA
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Griesser MJ, Beran MC, Flanigan DC, Quackenbush M, Van Hoff C, Bishop JY. Implementation of an objective structured clinical exam (OSCE) into orthopedic surgery residency training. JOURNAL OF SURGICAL EDUCATION 2012; 69:180-189. [PMID: 22365863 DOI: 10.1016/j.jsurg.2011.07.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 07/23/2011] [Accepted: 07/31/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE While the musculoskeletal (MSK) physical examination (PE) is an essential part of a patient encounter, we believe it is an underemphasized component of orthopedic residency education and that resident PE skills may be lacking. The purpose of this investigation was to (1) assess the attitudes regarding PE teaching in orthopedic residencies today; (2) develop an MSK objective structured clinical examination (OSCE) to assess the MSK PE knowledge and skills of our orthopedic residents. DESIGN Prospective, uncontrolled, observational. SETTING A major Midwestern tertiary referral center and academic medical center. PARTICIPANTS The orthopedic surgery residents in our program. Twenty-two of 24 completed the OSCE. RESULTS Surveys showed that residents agreed that although learning the PE is important, there is not enough time in clinic to actually observe and critique a resident examining a patient. For the 22 residents (postgraduate year [PGY] 2-5) who participated in the OSCE, the overall score was 66%. Scores were significantly better for the trauma scenario (78%; p < 0.05) than for the shoulder (67%), spine (64%), and knee (59%) encounters. The overall scores for each component of the OSCE were: (1) history 53%; (2) PE 60%; (3) 5-question posttest 64%; and (4) communication skills 90%. CONCLUSIONS We have exposed a deficiency in the PE knowledge and skills of our residents. Clinic time alone may be insufficient to both teach and learn the MSK PE. The use of a MSK OSCE, while novel in orthopedics, will allow more direct observation of our residents MSK PE skills and also allow us to follow resident skills longitudinally through their training. We hope that our efforts will encourage other programs to assess their PE curriculum and perhaps prompt change.
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Affiliation(s)
- Michael J Griesser
- Department of Orthopedics, Ohio State University, Columbus, OH 43221, USA
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Wenrich M, Jackson MB, Scherpbier AJ, Wolfhagen IH, Ramsey PG, Goldstein EA. Ready or not? Expectations of faculty and medical students for clinical skills preparation for clerkships. MEDICAL EDUCATION ONLINE 2010; 15:10.3402/meo.v15i0.5295. [PMID: 20711483 PMCID: PMC2919534 DOI: 10.3402/meo.v15i0.5295] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 07/07/2010] [Accepted: 07/13/2010] [Indexed: 05/16/2023]
Abstract
BACKGROUND Preclerkship clinical-skills training has received increasing attention as a foundational preparation for clerkships. Expectations among medical students and faculty regarding the clinical skills and level of skill mastery needed for starting clerkships are unknown. Medical students, faculty teaching in the preclinical setting, and clinical clerkship faculty may have differing expectations of students entering clerkships. If students' expectations differ from faculty expectations, students may experience anxiety. Alternately, congruent expectations among students and faculty may facilitate integrated and seamless student transitions to clerkships. AIMS To assess the congruence of expectations among preclerkship faculty, clerkship faculty, and medical students for the clinical skills and appropriate level of clinical-skills preparation needed to begin clerkships. METHODS Investigators surveyed preclinical faculty, clerkship faculty, and medical students early in their basic clerkships at a North American medical school that focuses on preclerkship clinical-skills development. Survey questions assessed expectations for the appropriate level of preparation in basic and advanced clinical skills for students entering clerkships. RESULTS Preclinical faculty and students had higher expectations than clerkship faculty for degree of preparation in most basic skills. Students had higher expectations than both faculty groups for advanced skills preparation. CONCLUSIONS Preclinical faculty, clerkship faculty, and medical students appear to have different expectations of clinical-skills training needed for clerkships. As American medical schools increasingly introduce clinical-skills training prior to clerkships, more attention to alignment, communication, and integration between preclinical and clerkship faculty will be important to establish common curricular agendas and increase integration of student learning. Clarification of skills expectations may also alleviate student anxiety about clerkships and enhance their learning.
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Affiliation(s)
- Marjorie Wenrich
- Office of the Dean, University of Washington School of Medicine, Seattle, WA, USA.
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Kim SH, Yang EB, Ahn DS, Jeon WT, Lyu CJ. The present conditions of clinical clerkship management in Korea. KOREAN JOURNAL OF MEDICAL EDUCATION 2009; 21:373-383. [PMID: 25813442 DOI: 10.3946/kjme.2009.21.4.373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Accepted: 09/18/2009] [Indexed: 06/04/2023]
Abstract
PURPOSE This study investigated the present conditions of clinical clerkship management in Korea to make recommendations for it. METHODS The data were collected between April 15 and May 30 in 2009 using questionnaires that were sent to the clerkship directors of 41 colleges of medicine and medical graduate schools. RESULTS The elective course system was established in 78% of the institutions; the 6 core specialties were found in all medical schools. The duration of clerkship was longest in internal medicine, followed by surgery, pediatrics, obstetrics and gynecology, psychiatry, and emergency medicine. There were differences between the planning and monitoring agencies. Preclinical courses existed in 92.7% of the institutions. However, much more remains to be done ie, with regard to the issues of student assessment in clinical clerkship, faculty development programs for the faculty and residents, incentive systems for educational involvement, provisions for yearly systematic clerkships, integration of basic-clinical science-medical humanities, and community-based education. CONCLUSION Because clinical clerkship education is very important as a core curriculum, curriculum planning and its management must be given adequate attention. The following measures are suggested: elective systems that allow students to choose by career planning; concerns over faculty development programs for residents as a teacher; consensus on the concept, objectives, duration, content, evaluation tools of pre-clinical clerkship and clinical clerkship, and student well-being; and emphasis on community-based education.
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Affiliation(s)
- Sang Hyun Kim
- BK21 project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Bae Yang
- Department of Medical Education, Yonsei University College of Medicine, Seoul, Korea
| | - Duck Sun Ahn
- Department of Physiology, Yonsei University College of Medicine, Seoul, Korea
| | - Woo Tack Jeon
- Department of Medical Education, Yonsei University College of Medicine, Seoul, Korea
| | - Chuhl Joo Lyu
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
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