Gender as a variable in the assessment of final year degree-level communication skills

E-learning modules to improve clinical reasoning and practice: a prospective comparative study

Background

Controversy remains about whether e-learning can improve clinical competences. Our study aimed to compare the effects of e-learning versus traditional education on medical students' reasoning and how they applied their knowledge to clinical competences, assess factors associated with e-learning that might influence exam scores, and evaluate medical students' satisfaction with these two learning methods.

Methods

Prospective study of 299 medical students in two fourth-year pediatric clerkship cohorts (2016-17 and 2017-18) in Switzerland.

Results

We found no evidence of a difference in students' reasoning or how they applied their knowledge to competences in clinical case resolution, whether they had followed e-learning modules or attended traditional lectures. The number of quizzes taken and being female were factors associated with better scores. Even though overall satisfaction with the two learning methods was similar, students claimed that they learned more in e-learning than in traditional lectures and that e-learning explained learning objectives better.

Conclusions

E-learning could be used as a supplement or alternative to traditional face-to-face medical teaching methods without compromising teaching quality. E-learning modules should be better integrated into medical students' curricula but avoid the risk of curriculum overload, especially in case of repeated COVID-like context.

The Use of Structured Oral Exams for the Assessment of Medical Students in their Radiology Clerkship

RATIONALE & OBJECTIVES

There is increasing interest in narrative feedback and competency-based evaluation in medical student education. This study evaluates the implementation of a structured oral exam for a required radiology clerkship in furtherance of these aims.

MATERIALS & METHODS

A structured oral exam was instituted in academic year (AY) 20-21. Students prepared to discuss 5 varied imaging cases as they would to a medical colleague and as to a patient. For AY 20-21, students took the oral and a written exam. In AY 21-22, students took the oral exam alone and the written exam was discontinued. The perceived educational value of clerkship components, including the oral and written exam, were scored by the students on a 5-point Likert scale.

RESULTS

All students in AY 20-21 received a passing score on the written (mean 89.0, SD 4.59) and oral exams. All students in AY 21-22 received a passing score on the oral exam. In AY 20-21, the educational value of the oral exam was rated significantly higher than that of the written exam (4.30 vs 4.02, P = 0.021). There was no significant difference in rating of the oral exam between AY 20-21 and AY 21-22 (4.30 vs 4.38; P = 0.499).

CONCLUSION

The implementation of a structured final oral exam for a required radiology clerkship was felt to be successful in the aims of delivering educational value while evaluating students for competency. Further evaluation of oral exams for radiology medical student education are warranted to optimize the career preparation of future physicians.

A structured multimodal teaching approach enhancing musculoskeletal physical examination skills among undergraduate medical students

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.

'I wouldn't know what to do with the breasts': the impact of patient gender on medical student confidence and comfort in clinical skills

BACKGROUND

Previous research has found a relationship between students' gender and attitudes surrounding peer physical examination, but relationship between patient gender and confidence/comfort is less clear. We explored whether patient gender affects medical students' levels of confidence and comfort in clinical examination skills.

METHODS

An electronic survey and focus groups were conducted with medical students from one UK institution. Students reported levels of confidence/comfort when carrying out clinical examinations on men/women. An inductive thematic analysis was performed.

RESULTS

Of a total of 1500 students provided with the opportunity to participate, ninety (6%) responded. For cardiovascular and respiratory examinations, confidence/comfort were higher when examining male-presenting patients. The opposite was true for mental state examinations. Barriers to confidence/comfort included perceiving males as a norm, difficulty navigating breasts, tutors' internalised gendered attitudes and a wider sociocultural issue. Facilitators of confidence/comfort included students relating to patients, embodying a professional role, gender blindness, and authentic clinical environments. Fewer than 20% (n = 18) of students felt they had enough opportunity to practice clinical skills on women, versus 90% (n = 82) on men.

CONCLUSION

Our study identified an area where students' confidence and comfort in clinical examinations could be enhanced within medical education. Changes were implemented in the institution under study's vocational skills teaching, which is rooted in general practice. Information on gender and clinical skills was provided within course handbooks, time was scheduled to discuss gender and clinical skills in small group settings, and equitable gender representation was ensured in clinical assessment.

Gender differences in repeat-year experience, clinical clerkship performance, and related examinations in Japanese medical students

While the number of female medical students is increasing in Japan, gender differences in medical school performance have not been studied extensively. This study aimed to compare gender differences in repeat-year experience, Clinical Clerkship (CC) performance, and related examinations in Japanese medical students. We retrospectively analyzed the number of repeat-year students and years to graduation for male and female medical students, and assessed gender differences in performance on computer-based testing (CBT) before CC, CC as evaluated by clinical teachers, the CC integrative test, and the graduation examination in 2018-2020 graduates from our medical school. Subgroup analyses excluding repeat-year students were also performed. From 2018 to 2020, 328 medical students graduated from our medical school. There were significantly fewer repeat-year female students compared to male students (P = .010), and the average number of years to graduate was significantly higher for male students than female students (P < .001). Female students showed higher scores and performance in all integrative tests and CC (P < .05, each). In analysis excluding repeat-year students, there were no significant gender difference in performance on the CBT, and CC integrative test, although female students significantly outperformed male students on the CC and graduation examination. Female medical students had a fewer number of repeat-years and performed better in the CC and graduation examination compared to their male counterparts.

Excellent Agreement of In-Person Scoring versus Scoring of Digitally Recorded Simulated Suture Skills Examination

This study's objective was to evaluate the agreement between in-person performance scores and digitally recorded assessment scores by the same examiner using a simulated suturing skill examination. With ethics approval, veterinary students underwent a simulated skills examination proctored by an in-person examiner and simultaneously digitally recorded using two wide-angle cameras mounted overtop and to the side of the surgical field. Performance scores were based on a nine-item rubric. In-person examination scores were compared for agreement with those obtained by blind review of the digital recording of the same session, by the same examiner, 6-18 months following the in-person examination. Thirty-nine students were enrolled. All rubric categories could be assessed during digital assessment of the recording from the camera mounted above the surgical area. In two instances, the side digital recording had to be reviewed to confirm correct needle holder grip. Concordance correlation between performance scores from in-person and post hoc digital assessment was excellent (r = .93). The excellent agreement between in-person and digital assessment suggests that digitally recording skills examinations can provide adequate suturing skills assessment, presenting several benefits. Digitally recorded assessment allows for anonymity, which can reduce assessor bias/favoritism, provide a record of performance that students can review and critically self-reflect upon, and reduce the number of in-person examiners required to complete surgical skills examinations. Additionally, digitally recorded assessment could become an option for students who experience anxiety performing a skills exam in the presence of an examiner.

Comparison of student performance in therapeutics and communications courses to outcomes of objective structured clinical examinations: A retrospective analysis

INTRODUCTION

The objective was to examine the association between course grades and objective structured clinical examination (OSCE) performances in a pharmacy student cohort.

METHODS

A retrospective analysis of demographics, final grades in the Therapeutics I through IV and Communications courses, and multiple OSCE scores (therapeutic knowledge and general communication skills [GCS]) was performed for two cohorts.

RESULTS

Female students scored higher than male students on the warfarin OSCE therapeutic knowledge (P = .008) and GCS scores (P = .02). Age was inversely correlated with warfarin OSCE therapeutic knowledge score (P = .001). The warfarin OSCE therapeutic knowledge score was positively related to Therapeutics II final grades (P < .001). The Communications course final grade was positively correlated to the warfarin OSCE faculty-rated GCS score (P = .005). Therapeutics final grades were not significantly related to station scores of a multi-station OSCE (P > .05). The final regression model included gender and Therapeutics II final grade and explained 6% of the variance in warfarin OSCE therapeutic knowledge scores.

CONCLUSIONS

A number of significant associations were found between demographics, final course grades, and specific OSCE scores. A regression model was significant, but only explained a low percentage of the warfarin OSCE therapeutic knowledge score variance, suggesting other factors not evaluated had a greater effect on scores. This research suggests that OSCEs play an important role in demonstrating student competency in educational domains other than knowledge and brings forth new data suggesting that age and/or gender may influence OSCE performance.

Gender Disparity and Potential Strategies for Improvement in Neurology and Clinical Neurophysiology

Discrimination in the workplace when documented is illegal but is seen to still exist in some forms whether based on culture, race, or gender. Each of these disparities warrants further discussion and study because of their significant impacts on hiring decisions, career advancement, and compensation. In this article, the authors have focused their attention on gender disparity in the fields of neurology and clinical neurophysiology and shared the data currently available to them. At a time when the field of clinical neurophysiology has seen enormous growth, gender disparity in leadership and compensation remain. Despite the increasing number of women entering the fields of neurology and clinical neurophysiology, women remain underrepresented in national leadership positions. Many women physicians report experiencing gender discrimination despite increasing efforts by universities and medical centers to improve inclusivity and diversity. Equity and inclusivity are not the same and there is a disconnect between the increased numbers of women and their shared experiences in the workplace. Implicit bias undermines the ability of women to advance in their careers. For neurologists, data indicate that the latest gender pay gap is $56,000 (24%), increased from $37,000 in 2015, and is one of the largest pay gaps in any medical specialty. One third of the top 12 medical schools in the United States require that maternity leave be taken through disability coverage and/or sick benefits, and most family leave policies constrain benefits to the discretion of departmental leadership. The authors recommend strategies to improve gender disparity include institutional training to Identify and overcome biases, changes to professional organizations and national scientific meeting structure, transparency in academic hiring, promotion and compensation, and mentorship and sponsorship programs.

Entrustable professional activities and facets of competence in a simulated workplace-based assessment for advanced medical students

Background: Competence-based assessment formats in medical education usually focus on individual facets of competence (FOCs). The concept of 'Entrustable Professional Activities' (EPAs) encompasses supervisors' decisions on which level of supervision a trainee requires to perform a professional activity including several FOCs. How the different FOCs as perceived by clinician raters contribute to entrustment decisions is yet unclear.Objective: How do FOC perceptions relate to entrustment-decisions?Methods: Sixty-seven advanced medical students participated in an assessment simulating the first day of a resident physician. Participants were rated by supervisors for seven FOCs and twelve EPAs.Results: There was a positive correlation between FOC and EPA scores. Each EPA displayed a different correlation pattern with FOC ratings.Discussion: For most EPAs high levels of entrustment were associated with high ratings for selected FOCs. The results are in alignment with the assumption that each EPA encompasses a different set of FOCs.Conclusions: In our simulated workplace-based assessment, entrustment decisions for EPAs reflect the FOCs observed in a trainee. Thus, assessment of FOCs alongside with EPA ratings could add to the understanding of factors contributing to entrustment decisions.

Deficits in history taking skills among final year medical students in a family medicine course: A study from KSA

OBJECTIVES

History taking is considered an important diagnostic tool in medicine. Medical students should be competent in focused history-taking skills to reach initial diagnosis. The aim of this study was to identify deficits in history-taking skills among final year medical students in family medicine courses in Qassim University, KSA.

METHODS

All objective structured clinical examination (OSCE) sheets were collected and analysed to evaluate the history-taking component of the final examination from 2016 until January 2018.

RESULTS

A total of 94 OSCE sheets were evaluated. Achievement in some history taking skills of the students was low (differential diagnosis 31.9%, alarming symptoms of disease 39.4%, clarification of major complaint-associated symptoms 47.9%, and stress, anxiety, and depression screening 59.6%). However, the students' performances were better with respect to communication skills in general and exploration of the patients' ideas, concerns, and expectations. Significantly more male than female students had a better performance in some skills such as facilitating technique, appropriately exploring major complaint-associated symptoms, enquiring about differential diagnoses, and to rule out alarm symptoms.

CONCLUSIONS

In this study, the students' performance was generally better with respect to communication skills and psychosocial history. However, the students showed poor knowledge in other aspects of history-taking skills as they failed to formulate more than one hypothesis and to ask about alarm symptoms. Teaching communication and clinical reasoning skills and connecting physical and psychosocial aspects of patient care promotes understanding of the patient as a whole and should be taught in all courses of the clinical phase, with emphasis on bedside training.

Personal and Job Factors Associated with Teachers’ Active Listening and Active Empathic Listening

Active listening is important for effective interpersonal communication, a prerequisite for successful teaching. The presented cross-sectional study examined personal and work factors associated to active listening in 3.995 Greek schools’ educators of all teaching levels and specialties. The study questionnaire posted on official and main teachers’ portals included personal and working data items, the Active Empathic Listening Scale (AELS), and the Active Listening Attitude Scale (ALAS). Multiple linear regression was used to identify independently associated factors with AELS and ALAS dimensions, and standardized regression coefficients were performed to measure the effect of independent variables. Regarding AELS, gender had the greatest effect on the Sensing subscale, followed by age and mental health promotion training. Years of teaching had the greatest effect on Processing subscale, followed by higher studies. Gender had the greatest effect on Responding subscale, followed by age, higher studies, and mental health promotion training. Concerning ALAS, mental health promotion training and support from colleagues had the greatest effect on Listening attitude subscale, gender and mental health promotion training had the greatest effect on Listening skill subscale, and gender, age, and years of teaching had the greatest effect on Conversation opportunity subscale. The identification of enhancing factors like training in mental health promotion could significantly contribute in designing training that can simultaneously benefit teachers’ skills and students’ psychosocial well-being.

Examiner characteristics and interrater reliability in a communication OSCE

OBJECTIVE

To identify inter-individual examiner factors associated with interrater reliability in a summative communication OSCE in the 4th study year.

METHODS

The OSCE consists of 4 stations assessed with a 4-item 5-point global rating instrument. A bivariate secondary analysis of interrater reliability in relation to 4 examiner factors (gender, profession, OSCE experience, examiner training) was conducted. Intraclass correlation coefficients (ICC) were calculated and compared between examiner dyads of different similarity.

RESULTS

169 pairwise ratings from 19 different examiners in 16 dyads were analysed. Interrater reliability is significantly higher in examiner dyads of same vs. different gender (ICC=0.76 (95%CI=0.65-0.83) vs. ICC=0.41 (95%CI=0.21-0.57)), in dyads of two clinicians vs. non-clinical/mixed professions (ICC=0.72 (95%CI=0.56-0.83) vs. ICC=0.57 (95%CI=0.41-0.69)), and in dyads with high vs. low/mixed OSCE experience (ICC=0.73 (95%CI 0.50-0.87) vs. ICC=0.56 (95%CI=0.41-0.69)). Participation in recent examiner training had no influence on ICCs.

CONCLUSION

Better concordance of ratings between clinically active examiners might be a hint for context specificity of good communication. Higher interrater reliability between examiners with same gender may indicate gender-specific communication concepts.

PRACTICE IMPLICATIONS

Medical faculties introducing summative assessment of communication competence should focus the influence of examiner characteristics on interrater reliability.

Communication skills of medical students during the OSCE: Gender-specific differences in a longitudinal trend study

BACKGROUND

Communication skills are essential in a patient-centred health service and therefore in medical teaching. Although significant differences in communication behaviour of male and female students are known, gender differences in the performance of students are still under-reported. The aim of this study was to analyse gender differences in communication skills of medical students in the context of an OSCE exam (OSCE = Objective Structured Clinical Examination).

METHODS

In a longitudinal trend study based on seven semester-cohorts, it was analysed if there are gender differences in medical students' communication skills. The students (self-perception) and standardized patients (SP) (external perception) were asked to rate the communication skills using uniform questionnaires. Statistical analysis was performed by using frequency analyses and t-tests in SPSS 21.

RESULTS

Across all ratings in the self- and the external perception, there was a significant gender difference in favour of female students performing better in the dimensions of empathy, structure, verbal expression and non-verbal expression. The results of male students deteriorated across all dimensions in the external perception between 2011 and 2014.

DISCUSSION & CONCLUSION

It is important to consider if gender-specific teaching should be developed, considering the reported differences between female and male students.

Examiner effect on the objective structured clinical exam - a study at five medical schools

BACKGROUND

The Objective Structured Clinical Examination (OSCE) is increasingly used at medical schools to assess practical competencies. To compare the outcomes of students at different medical schools, we introduced standardized OSCE stations with identical checklists.

METHODS

We investigated examiner bias at standardized OSCE stations for knee- and shoulder-joint examinations, which were implemented into the surgical OSCE at five different medical schools. The checklists for the assessment consisted of part A for knowledge and performance of the skill and part B for communication and interaction with the patient. At each medical faculty, one reference examiner also scored independently to the local examiner. The scores from both examiners were compared and analysed for inter-rater reliability and correlation with the level of clinical experience. Possible gender bias was also evaluated.

RESULTS

In part A of the checklist, local examiners graded students higher compared to the reference examiner; in part B of the checklist, there was no trend to the findings. The inter-rater reliability was weak, and the scoring correlated only weakly with the examiner's level of experience. Female examiners rated generally higher, but male examiners scored significantly higher if the examinee was female.

CONCLUSIONS

These findings of examiner effects, even in standardized situations, may influence outcome even when students perform equally well. Examiners need to be made aware of these biases prior to examining.

Characteristics and Gender Differences in the Medical Interview Skills of Japanese Medical Students

Objective To examine the characteristics of the communication skills of medical students, we observed their performance during introductory medical interview training with simulated patients (SPs). Methods The subjects of the present study included fifth-year medical students (male, n=180, female, n=99) who were undergoing clinical training in Japan from 2012 to 2014. Each student was assigned to one of four 10-minute clinical scenarios, which was conducted with an SP. Three or four teachers observed and assessed the performance of each of the students. The overall performance was rated on a 10-point scale, and nine basic communication skills that were common to each of the scenarios were rated using a four-point scale. The students also assessed their own performance on these items. The SPs assessed the students' performance from a patient's perspective on four items. Results There were significant correlations between the teacher and student scores. However, the students tended to score themselves significantly lower than the teachers. The female students were rated significantly higher by the teachers on the following four items; 'eye contact and appropriate attitude,' 'nodding and back-channeling,' 'giving empathic verbal responses,' and 'acquisition of patient's psychosocial information.' However, the self-assessments of the female students were only significantly higher than the male students in one item, 'acquisition of patient's psychosocial information.' In contrast, self-assessments of the male students were significantly higher in two items; none of their items was scored higher by the teachers. There was no significant gender difference in the assessments made by the SPs. Conclusion There were significant gender differences in the communication skills of the medical students during introductory training, suggesting the possibility that there were gender-specific traits and gender-based differences in the students' degrees of readiness.

Communication skills in medical students - An exploratory study before and after clerkships

INTRODUCTION

Effective communication is the cornerstone of a fruitful patient-physician relationship. Teaching clinical communication has become a pivotal goal in medical education. However, approaches measuring the maintenance of learned skills are needed since a decline in some communication skills during medical school has been reported.

OBJECTIVE

Explore medical students' communication skills in a simulated clinical encounter before and after clerkships.

METHODS

Two-hundred-fifty-five undergraduate students attending the second year of medical course, at the Faculty of Medicine of University of Porto, completed a 1.5-h per week course over 4 months on basic communication skills. The students' final evaluation consisted in an interview with a simulated patient, assessed by a teacher using a standardized framework. Three years later, while attending clerkships, 68 students from the same population completed a re-evaluation interview following the same procedure.

RESULTS

Medical students maintained a communication skill mean level similar to that of the original post-training evaluation, but significant differences in specific communication abilities were detected in this group of students. Empathic attitudes and ability to collect information improved whereas interview structure and non-verbal behavior showed a decline during clerkships expressing a balance between the competencies that improved, those that declined, and those that remained unchanged.

CONCLUSION

Present findings emphasize the importance of patient contact, context and clinical role models on the maintenance of learned skills, underscoring the importance of an integrated approach of clinical communication teaching throughout medical school.

Do role-players affect the outcome of a high-stakes postgraduate OSCE, in terms of candidate sex or ethnicity? Results from an analysis of the 52,702 anonymised case scores from one year of the MRCGP clinical skills assessment

The MRCGP clinical skills assessment (CSA), a high-stakes OSCE examination whereby GPs exit their training, uses trained role-players to depict patients (though not to mark candidates). Just as subgroups of examiners can potentially affect the results of subgroups of candidates through biases expressed in discriminatory marking, so possibly could subgroups of role-players alter the difficulty for different candidate groups. This study looks at the contribution of role-players to such possible systematic unfairness in the assessment. Using multiple linear regression, we examined the data from all 52,702 case scores from the MRCGP CSA for the academic year 2012-2013. Candidates were dichotomised by sex, by ethnicity and by source of primary medical qualification (PMQ); role-players were dichotomised by sex and binary ethnicity; and the transaction of candidate/role-player encounters were classified as 'same' or 'different' in terms of the two parties' sex and of their ethnicity. Neither examiner nor role-player characteristics were found to predict any statistically significant portion of case score variance, where the significant (p < .001) predictors were source of PMQ (UK or elsewhere: 11% of case score variance), candidates' ethnicity (1%), candidates' sex (0.6%) and 'transactional' sex (0.1%). We did not therefore find any substantial degree of support for the proposition that role-player subgroups systematically influence candidate subgroups' scores.

Influence of a revision course and the gender of examiners on the grades of the final ENT exam--a retrospective review of 3961 exams

Revision courses should repeat already acquired knowledge and skills and mostly provide a basis for passing the following exam.

Aim: The aim of the study is to investigate the influence of a previously attended revision course on the grades achieved in a final exam (Ear, Nose and Throat Diseases). Additionally we ask the question whether the gender of the examiners plays a role concerning the marks or not.

Methods: 3961 exams at the Department of Ear, Nose and Throat (ENT) Diseases in Vienna were investigated, 725 with revision course (experimental group) and 3236 without previous revision course (comparison group). The revision courses were performed in a standardized way concerning form and content, interactive and case based.

Both groups were examined uniform in regard to topics and time duration. 16 male and 6 female examiners were involved. The grading followed a five–level scale. The examination marks were calculated in the arithmetic mean and median value for the entire sample, gender dependence was calculated according to the Wilcoxon-Mann-Whitney-Test. The inferential statistics included single- and multiple factorial analyses of variance as well as uni- and multivariate regression models.

Results: The experimental group achieved a grade average of 2.54 compared with 2.46 for the comparison group. Splitting up into male and female examiners, an average of 2.54 and 2.58 resp. for the experimental group and 2.44 and 2.61 resp. for the comparison group resulted. Female examiner marked significantly lower grades in comparison to their male colleagues (P= 0.001926).

Conclusions: The ENT revision course did not improve the grade averages of the final ENT exam. Female examiners grade stricter than male examiners. There was no difference concerning grades 4 (pass) and 5 (fail) but female examiners grade less with mark 1.

Development, validation and initial outcomes of a questionnaire to examine human factors in postgraduate surgical objective structured clinical examinations

Background

Human factors including stress, repetition, burnout and fatigue are associated with possible sources of error. Objective structured clinical examinations (OSCEs), where examiners concentrate for long periods, would benefit from a human factors approach to see whether these factors affect consistency of examiner behaviour, attitude and marking. Little has been published for OSCEs, in part due to the lack of a validated tool for collecting data in this setting.

Methods

A 46-item questionnaire was developed based on the Human Factors Analysis and Classification System (HFACS) domains and completed by examiners in the Intercollegiate Membership of the Royal College of Surgeons (MRCS) examination. To refine the questionnaire, an initial analysis focused on response patterns of each item. Cronbach's α was used to assess internal consistency, and a factor analysis was performed to uncover different domains emerging from the data.

Results

A total of 108 examiners completed the questionnaire (90·0 per cent response rate). The questionnaire, refined to 38 items based on an initial analysis of response patterns, showed good reliability for internal consistency (Cronbach's α = 0·76) and test–retest reliability (r = 0·85, n = 48, P &lt; 0·001). Four factors had a close themed resemblance to the original HFACS domains, but were associated with different items, suggesting that the four human-factor domains might be linked to different behaviours and attitudes in an examination setting. Analyses according to sex, professional background and experience highlighted additional stress levels in examiners from one of the surgical Royal Colleges (P &lt;0·001), matching evidence from the situation in that College at the time of this study.

Conclusion

The recognition and further investigation of human factors in OSCEs is needed to improve examiner experience and behaviour in order to influence delivery, candidate experience and quality assurance of these examinations.

Reliability of the interprofessional collaborator assessment rubric (ICAR) in multi source feedback (MSF) with post-graduate medical residents

BACKGROUND

Increased attention on collaboration and teamwork competency development in medical education has raised the need for valid and reliable approaches to the assessment of collaboration competencies in post-graduate medical education. The purpose of this study was to evaluate the reliability of a modified Interprofessional Collaborator Assessment Rubric (ICAR) in a multi-source feedback (MSF) process for assessing post-graduate medical residents' collaborator competencies.

METHODS

Post-graduate medical residents (n = 16) received ICAR assessments from three different rater groups (physicians, nurses and allied health professionals) over a four-week rotation. Internal consistency, inter-rater reliability, inter-group differences and relationship between rater characteristics and ICAR scores were analyzed using Cronbach's alpha, one-way and two-way repeated measures ANOVA, and logistic regression.

RESULTS

Missing data decreased from 13.1% using daily assessments to 8.8% utilizing an MSF process, p = .032. High internal consistency measures were demonstrated for overall ICAR scores (α = .981) and individual assessment domains within the ICAR (α = .881 to .963). There were no significant differences between scores of physician, nurse, and allied health raters on collaborator competencies (F2,5 = 1.225, p = .297, η2 = .016). Rater gender was the only significant factor influencing scores with female raters scoring residents significantly lower than male raters (6.12 v. 6.82; F1,5 = 7.184, p = .008, η 2 = .045).

CONCLUSION

The study findings suggest that the use of the modified ICAR in a MSF assessment process could be a feasible and reliable assessment approach to providing formative feedback to post-graduate medical residents on collaborator competencies.

Summative assessment of undergraduates' communication competence in challenging doctor-patient encounters. Evaluation of the Düsseldorf CoMeD-OSCE

OBJECTIVE

To evaluate the summative assessment (OSCE) of a communication training programme for dealing with challenging doctor-patient encounters in the 4th study year.

METHODS

Our OSCE consists of 4 stations (breaking bad news, guilt and shame, aggressive patients, shared decision making), using a 4-item global rating (GR) instrument. We calculated reliability coefficients for different levels, discriminability of single items and interrater reliability. Validity was estimated by gender differences and accordance between GR and a checklist.

RESULTS

In a pooled sample of 456 students in 3 OSCEs over 3 terms, total reliability was α=0.64, reliability coefficients for single stations were >0.80, and discriminability in 3 of 4 stations was within the range of 0.4-0.7. Except for one station, interrater reliability was moderate to strong. Reliability on item level was poor and pointed to some problems with the use of the GR.

CONCLUSION

The application of the GR on regular undergraduate medical education shows moderate reliability in need of improvement and some traits of validity. Ongoing development and evaluation is needed with particular regard to the training of the examiners.

PRACTICE IMPLICATIONS

Our CoMeD-OSCE proved suitable for the summative assessment of communication skills in challenging doctor-patient encounters.

How do United Kingdom (UK) medical schools identify and support undergraduate medical students who 'fail' communication assessments? A national survey

BACKGROUND

The doctor's ability to communicate effectively (with patients, relatives, advocates and healthcare colleagues) relates directly to health outcomes, and so is core to clinical practice. The remediation of medical students' clinical communication ability is rarely addressed in medical education literature. There is nothing in the current literature reporting a contemporary national picture of how communication difficulties are managed, and the level of consequence (progression implications) for students of performing poorly. This survey aimed to consolidate practices for identifying and processes for managing students who 'fail' communication assessments across all UK medical schools.

METHODS

Data were collected via an email survey to all leads for clinical communication in all UK Medical Schools for the UK Council for Clinical Communication in Undergraduate Medical Education.

RESULTS

All but two participating Schools reported some means of support and/or remediation in communication. There was diversity of approach, and variance in the level of systemisation adopted. Variables such as individuality of curricula, resourcing issues, student cohort size and methodological preferences were implicated as explaining diversity. Support is relatively ad hoc, and often in the hands of a particular dedicated individual or team with an interest in communication delivery with few Schools reporting robust, centralised, school level processes.

CONCLUSIONS

This survey has demonstrated that few Medical Schools have no identifiable system of managing their students' clinical communication difficulties. However, some Schools reported ad hoc approaches and only a small number had a centralised programme. There is scope for discussion and benchmarking of best practice across all Schools with allocation of appropriate resources to support this.

How do gender and anxiety affect students' self-assessment and actual performance on a high-stakes clinical skills examination?

PURPOSE

Research suggests that medical students are not accurate in self-assessment, but it is not clear whether students over- or underestimate their skills or how certain characteristics correlate with accuracy in self-assessment. The goal of this study was to determine the effect of gender and anxiety on accuracy of students' self-assessment and on actual performance in the context of a high-stakes assessment.

METHOD

Prior to their fourth year of medical school, two classes of medical students at Johns Hopkins University School of Medicine completed a required clinical skills exam in fall 2010 and 2011, respectively. Two hundred two students rated their anxiety in anticipation of the exam and predicted their overall scores in the history taking and physical examination performance domains. A self-assessment deviation score was calculated by subtracting each student's predicted score from his or her score as rated by standardized patients.

RESULTS

When students self-assessed their data gathering performance, there was a weak negative correlation between their predicted scores and their actual scores on the examination. Additionally, there was an interaction effect of anxiety and gender on both self-assessment deviation scores and actual performance. Specifically, females with high anxiety were more accurate in self-assessment and achieved higher actual scores compared with males with high anxiety. No differences by gender emerged for students with moderate or low anxiety.

CONCLUSIONS

Educators should take into account not only gender but also the role of emotion, in this case anxiety, when planning interventions to help improve accuracy of students' self-assessment.

Medical misconduct in Hong Kong: implications for medical education around the world

CONTEXT

Medical educators emphasise responses to medical misconduct, but little is known about medical misconduct and its implications for medical education. This article investigates the nature of medical malpractice in Hong Kong and offers guidance for the inclusion of a curriculum to prevent the occurrence of medical misconduct in medical education around the world.

METHODS

A comprehensive review of judgements made by the Medical Council of Hong Kong during the period from July 2008 to December 2010 was conducted. Each of the 40 cases of inquiry related to medical misconduct were summarised and analysed according to 14 factors.

RESULTS

Of the 40 cases, nearly half involved only one or two charges. The Council found the defendants guilty of professional misconduct on 148 of 169 charges, and ordered the following four types of penalty: removal order, suspension, warning letter, and reprimand. Cases are grouped into three categories involving: improper documentation, inappropriate management or prescription of drugs, and failure to interact appropriately with patients. The relevant ethical codes or legislation for each category are illustrated.

CONCLUSIONS

Various types of medical misconduct unquestionably caused suffering to the patients involved, their families and society. Hence, it is crucial for medical educators to teach students about the importance of medical ethics and the prevention of misconduct.

Comparing performance among male and female candidates in sex-specific clinical knowledge in the MRCGP

BACKGROUND

Patients often seek doctors of the same sex, particularly for sex-specific complaints and also because of a perception that doctors have greater knowledge of complaints relating to their own sex. Few studies have investigated differences in knowledge by sex of candidate on sex-specific questions in medical examinations.

AIM

The aim was to compare the performance of males and females in sex-specific questions in a 200-item computer-based applied knowledge test for licensing UK GPs.

DESIGN AND SETTING

A cross-sectional design using routinely collected performance and demographic data from the first three versions of the Applied Knowledge Test, MRCGP, UK.

METHOD

Questions were classified as female specific, male specific, or sex neutral. The performance of males and females was analysed using multiple analysis of covariance after adjusting for sex-neutral score and demographic confounders.

RESULTS

Data were included from 3627 candidates. After adjusting for sex-neutral score, age, time since qualification, year of speciality training, ethnicity, and country of primary medical qualification, there were differences in performance in sex-specific questions. Males performed worse than females on female-specific questions (-4.2%, 95% confidence interval [CI] = -5.7 to -2.6) but did not perform significantly better than females on male-specific questions (0.3%, 95% CI = -2.6 to 3.2%.

CONCLUSION

There was evidence of better performance by females in female-specific questions but this was small relative to the size of the test. Differential performance of males and females in sex-specific questions in a licensing examination may have implications for vocational and post-qualification general practice training.

Pre-registration dietetic students' attitudes to learning communication skills

BACKGROUND

  Communication is a core skill and a prerequisite for dietitians' clinical competence. It is generally acknowledged that communication skills can be taught and learned. There is a paucity of published work identifying dietetic students' attitudes towards learning communication skills, and understanding this is important.

METHODS

  The present cross-sectional study aimed to address this issue using an adapted version of the Communication Skills Attitude Scale (CSAS), which was designed to capture information concerning positive and negative attitudes to learning communication skills. An online questionnaire was sent to all undergraduate and post-graduate dietetic programmes in the UK.

RESULTS

  Of the students' solicited for enrolment in the study, 33.4% (n = 300) completed the questionnaire. A one-way analysis of variance showed attitudes to learning communication skills differed significantly between years of study on both subscales of the CSAS. Subsequent analyses indicated that first-year students' attitudes to learning communication skills were significantly more positive than those of fourth-year students (P = 0.042). Third-year students had significantly more positive attitudes to learning communication skills than fourth-year students (P = 0.028). Negative attitudes were also linked to the year of study with fourth-year students having significantly more negative attitudes than third-year students (P = 0.046). Sex, practice placement experience and parental occupation did not significantly influence attitudes to learning communication skills.

CONCLUSIONS

  These findings indicate that efforts are required to maintain positive attitudes to learning communication skills. Further longitudinal studies are recommended in this respect.

Clinical assessment performance of graduate- and undergraduate-entry medical students

BACKGROUND

Recent evidence suggests that graduate-entry medical students may have a marginal academic performance advantage over undergraduate entrants in a pre-clinical curriculum in both bioscience knowledge and clinical skills assessments. It is unclear whether this advantage is maintained in the clinical phase of medical training.

AIM

The study aimed to compare graduate and undergraduate entrants undertaking an identical clinical curriculum on assessments undertaken during clinical training in the medical course.

METHODS

Clinical assessment results for four cohorts of medical students (n = 713) were compared at the beginning and at the end of clinical training for graduate and undergraduate entrants.

RESULTS

Results showed that graduate- and undergraduate-entry medical students performed similarly on clinical assessments. Female students performed consistently better than male students.

CONCLUSION

The findings of this study suggest that any academic performance advantage held by graduate-entry medical students is limited to the early years of the medical course, and is not evident during clinical training in the later years of the course.

Does the inclusion of 'professional development' teaching improve medical students' communication skills?

BACKGROUND

This study investigated whether the introduction of professional development teaching in the first two years of a medical course improved students' observed communication skills with simulated patients. Students' observed communication skills were related to patient-centred attitudes, confidence in communicating with patients and performance in later clinical examinations.

METHODS

Eighty-two medical students from two consecutive cohorts at a UK medical school completed two videoed consultations with a simulated patient: one at the beginning of year 1 and one at the end of year 2. Group 1 (n = 35) received a traditional pre-clinical curriculum. Group 2 (n = 47) received a curriculum that included communication skills training integrated into a 'professional development' vertical module. Videoed consultations were rated using the Evans Interview Rating Scale by communication skills tutors. A subset of 27% were double-coded. Inter-rater reliability is reported.

RESULTS

Students who had received the professional development teaching achieved higher ratings for use of silence, not interrupting the patient, and keeping the discussion relevant compared to students receiving the traditional curriculum. Patient-centred attitudes were not related to observed communication. Students who were less nervous and felt they knew how to listen were rated as better communicators. Students receiving the traditional curriculum and who had been rated as better communicators when they entered medical school performed less well in the final year clinical examination.

CONCLUSIONS

Students receiving the professional development training showed significant improvements in certain communication skills, but students in both cohorts improved over time. The lack of a relationship between observed communication skills and patient-centred attitudes may be a reflection of students' inexperience in working with patients, resulting in 'patient-centredness' being an abstract concept. Students in the early years of their medical course may benefit from further opportunities to practise basic communication skills on a one-to-one basis with patients.

Role-playing in the problem-based learning class

Learning and teaching have been conceptualized and executed in many styles, such as self-learning, peer learning, and interaction between the learner and mentor. Today, openness to alternative ideas and embracing innovative approaches in nursing education are encouraged in order to meet students' learning interests and needs, and to address ever-changing healthcare requests. Problem-based learning has been widely adopted in nursing education, with various positive effects on students' learning, such as motivated learning, team work, problem-solving skills and critical thinking. Role-plays have been demonstrated as an effective learning strategy that includes an active and experiential feature that facilitates students' autonomy in their health-related learning. However, there is a lack of discussion of whether and how role-play can be used in problem-based learning (PBL). This paper shows the development of a classroom-based innovation using role-play in the PBL class for higher diploma year-one nurse students (a total of 20 students, five per group). This paper consists of five sections: a) the literature on PBL and nurse education, and role-plays as the innovation; b) the PBL case scenario with the illustration of the two role-play scripts, c) student evaluation on role-play in the PBL class; d) discussions on both achievements and limitations of this innovation, and e) the conclusion. It is hoped that this paper will be an example to other nurse educators who are keen on exploring interactive and student-driven learning and teaching strategies in the PBL class.

The effect of gender interactions on students' physical examination ratings in objective structured clinical examination stations

PURPOSE

Previous studies have reached a variety of conclusions regarding the effect of gender on performance in objective structured clinical examinations (OSCEs). Most measured the effect on students' overall OSCE score. The authors of this study evaluated the effect of gender on the scores of specific physical examination OSCE stations, both "gender-sensitive" and "gender-neutral."

METHOD

In 2008, the authors collected scores for 138 second-year medical students at the University of Calgary who underwent a seven-station OSCE. Two stations--precordial and respiratory exams--were considered gender-sensitive. Multiple linear regression was used to explore the effect of students', standardized patients' (SPs'), and raters' genders on the students' scores.

RESULTS

All 138 students (69 female) completed the OSCE and were included in the analyses. The mean scores (SD) for the two stations involving examination of the chest were higher for female than for male students (83.2% [15.5] versus 78.3% [15.8], respectively, d = 0.3, P = .009). There was a significant interaction between student and SP gender (P = .02). In the stratified analysis, female students were rated significantly higher than male students at stations with female SPs (85.4% [15.5] versus 76.6% [16.5], d = 0.6, P = .004) but not at stations with male SPs (80.2% [15.0] versus 80.0% [15.0], P = 1.0).

CONCLUSION

These results suggest student and SP genders interact to affect OSCE scores at stations that require examination of the chest. Further investigations are warranted to ensure that the OSCE is an equal experience for all students.

Gender bias in patients' perceptions of patient-centered behaviors

OBJECTIVE

This research examines whether patient perceptions are equivalently associated with patient-centered behavior in male and female medical students, and tests the impact of a message emphasizing the importance of patient-centeredness on analogue patients' perceptions of male and female medical students' performance.

METHODS

Sixty-one medical students interacting with standardized patients (SPs) were viewed by 384 analogue patients (APs). APs were randomly assigned to receive a message emphasizing the value of patient-centeredness or of technical competence, or a neutral message, and then evaluated the medical students' competence in the interactions. Students' patient-centeredness was measured using the Four Habits Coding Scheme and Roter Interaction Analysis System.

RESULTS

APs in the neutral and technical competence conditions gave higher competence ratings to more patient-centered male students, but not to more patient-centered female students. However, APs who received the patient-centeredness message gave higher competence ratings to both male and female students who were higher in patient-centeredness.

CONCLUSION

Making it clear that patient-centeredness is a dimension of physician competence eliminated a gender bias in evaluating performance.

PRACTICE IMPLICATIONS

Because patient perceptions are often used in evaluations, gender biases must be understood and reduced so both male and female providers receive appropriate credit for their patient-centered behaviors.

Is the OSCE more stressful? Examination anxiety and its consequences in different assessment methods in dental education

OBJECTIVE

To measure the levels of anxiety, self-perception of preparation and expectation for success induced by an objective structured clinical examination (OSCE), a written examination and a preclinical preparation test, and to examine the effects of the three predictive variables on the outcome of the assessments.

MATERIALS AND METHODS

Test anxiety was measured with Spielberger's state anxiety inventory. Preparation for the assessment and expectation to succeed were quantified with 4-point Likert scales. The questionnaire was completed during an OSCE, a written examination, a preclinical crown and bridge preparation test and a non-examination situation.

RESULTS

The OSCE was a most anxiety-provoking assessment method and students prepared more for the OSCE than for the other examinations. The expectation to succeed was also higher for the OSCE. State anxiety during the OSCE was associated with the level of preparation but not with scores obtained. The state anxiety during a written examination showed a positive relation with the scores obtained, but not with preparation or expectation to succeed. During the preclinical test, state anxiety showed a positive association with the preparation and expectation to succeed, but not with the scores for this test. No significant gender effects were observed for the state anxiety, level of preparation or the expectation to pass the examination. In the written examination female students scored significantly higher than male students. Such a gender effect was not found for the scores of the OSCE or the preclinical test.

CONCLUSION

State anxiety was elevated during all three assessment methods. However, anxiety was not predictive of performance outcome in the OSCE, written examination or preclinical preparation test.

Evidence of gender bias in True-False-Abstain medical examinations

BACKGROUND

There is evidence that males and females differ in their attainment on a variety of assessments in general and in medical education. It has been suggested that the True-False-Abstain (TFA) format with negative marking is biased against females.

METHODS

Eight years worth of examination data from the first two years of an undergraduate medical curriculum was analysed. 359 courses were evaluated for statistically significant differences between the genders using ANOVA. Logistic regression was used to test if subject area, calendar year or exam format predicted that males or females do better (termed male advantage or female advantage).

RESULTS

Statistically significant differences between the genders were found in 111 (31%) of assessments with females doing better than males in 85 and males better in 26. Female advantage was associated with a particular year (2001), the Personal and Professional Development strand of the curriculum, in course assessment and short answer questions. Male advantage was associated with the anatomy and physiology strand of the curriculum and examinations containing TFA formats, where the largest gender difference was noted. Males were 16.7 times more likely than females to do better on an assessment if it had any questions using the TFA format.

CONCLUSION

Although a range of statistically significant gender differences was found, they were concentrated in TFA and short answer formats. The largest effect was for TFA formats where males were much more likely to do better than females. The gender bias of TFA assessments in medical education is yet another reason why caution should be exercised in their use.

Does the gender of the standardised patient influence candidate performance in an objective structured clinical examination?

CONTEXT

The objective structured clinical examination (OSCE) requires the use of standardised patients (SPs). Recruitment of SPs can be challenging and factors assumed to be neutral may vary between SPs. On stations that are considered gender-neutral, either male or female SPs may be used. This may lead to an increase in measurement error. Prior studies on SP gender have often confounded gender with case.

OBJECTIVE

The objective of this study was to assess whether a variation in SP gender on the same case resulted in a systematic difference in student scores.

METHODS

At the University of Ottawa, 140 Year 3 medical students participated in a 10-station OSCE. Two physical examination stations were selected for study because they were perceived to be 'gender-neutral'. One station involved the physical examination of the back and the other of the lymphatic system. On each of the study stations, male and female SPs were randomly allocated.

RESULTS

There was no difference in mean scores on the back examination station for students with female (6.96/10.00) versus male (7.04/10.00) SPs (P = 0.713). However, scores on the lymphatic system examination station showed a significant difference, favouring students with female (8.30/10.00) versus male (7.41/10.00) SPs (P < 0.001). Results were not dependent on student gender.

CONCLUSIONS

The gender of the SP may significantly affect student performance in an undergraduate OSCE in a manner that appears to be unrelated to student gender. It would be prudent to use the same SP gender for the same case, even on seemingly gender-neutral stations.

Medical student gender and issues of confidence

OBJECTIVE

To review the literature on gender differences and issues of self-confidence in medical students and to present original research on observers' perceptions of medical student confidence.

METHODS

One hundred forty-one 3rd year medical students at Indiana University School of Medicine were videotaped during their objective structured clinical examination (OSCE). Trained coders rated how confident the student appeared and coded a variety of nonverbal behaviors at the beginning, middle, and end of the interaction. Analysis focused on gender differences in coders' ratings of perceived confidence.

RESULTS

Female medical students were viewed as significantly less confident than male medical students (F(1,133)=4.45, p<0.05), especially at the beginning of the interaction.

CONCLUSION

Past research indicates that despite performing equally to their male peers, female medical students consistently report decreased self-confidence and increased anxiety, particularly over issues related to their competence. In a standardized patient interaction examination situation, female medical students also appeared significantly less confident than male medical students to independent observers.

PRACTICE IMPLICATIONS

Medical educators should focus on issues of female students' confidence, increasing faculty sensitivity, and publicly recognizing and discussing perceptions of confidence.

Performance in the MRCP(UK) Examination 2003-4: analysis of pass rates of UK graduates in relation to self-declared ethnicity and gender

BACKGROUND

Male students and students from ethnic minorities have been reported to under-perform in undergraduate medical examinations. We examined the effects of ethnicity and gender on pass rates in UK medical graduates sitting the Membership of the Royal Colleges of Physicians in the United Kingdom [MRCP(UK)] Examination in 2003-4.

METHODS

Pass rates for each part of the examination were analysed for differences between graduate groupings based on self-declared ethnicity and gender.

RESULTS

All candidates declared their gender, and 84-90% declared their ethnicity. In all three parts of the examination, white candidates performed better than other ethnic groups (P < 0.001). In the MRCP(UK) Part 1 and Part 2 Written Examinations, there was no significant difference in pass rate between male and female graduates, nor was there any interaction between gender and ethnicity. In the Part 2 Clinical Examination (Practical Assessment of Clinical Examination Skills, PACES), women performed better than did men (P < 0.001). Non-white men performed more poorly than expected, relative to white men or non-white women. Analysis of individual station marks showed significant interaction between candidate and examiner ethnicity for performance on communication skills (P = 0.011), but not on clinical skills (P = 0.176). Analysis of overall average marks showed no interaction between candidate gender and the number of assessments made by female examiners (P = 0.151).

CONCLUSION

The cause of these differences is most likely to be multifactorial, but cannot be readily explained in terms of previous educational experience or differential performance on particular parts of the examination. Potential examiner prejudice, significant only in the cases where there were two non-white examiners and the candidate was non-white, might indicate different cultural interpretations of the judgements being made.

Using standardized patients to assess the interpersonal skills of physicians: six years' experience with a high-stakes certification examination

Communication and interpersonal skills are essential elements of a physician's clinical expertise. Since 1998, the interpersonal competencies of over 37,000 internationally-trained physicians have been assessed as part of the Educational Commission for Foreign Medical Graduates (ECFMG) Clinical Skills Assessment (CSA). Standardized patients (SPs) provided ratings of interpersonal skills along 4 dimensions: skills in interviewing and collecting information; skills in counseling and delivering information; rapport; and personal manner. The content of the rating scale, the development and implementation of training materials and procedures, and the psychometric characteristics of the measures are described. Data from over 400,000 simulated patient encounters were analyzed. Correlations with other measures supported the construct validity of the assessment. A generalizability study showed that the ratings were reproducible over encounters. Analysis of individual SP ratings indicated that they were consistent in their application of the scoring rubric. Overall, the findings indicate that SPs, with proper training and a benchmarked scoring rubric, can provide accurate and defensible ratings of physicians' interpersonal skills. These results may also generalize to other clinical skills assessments, or other evaluations that employ raters to judge communication abilities.

Implementing an Objective Structured Clinical Examination (OSCE) in dental education: effects on students' learning strategies

OBJECTIVES

To investigate the effect of an Objective Structured Clinical Examination (OSCE) on dental students' learning strategies and competence to manage periodontal diseases in patients. The implemented OSCE was expected to be superior to the existing Written Exam in fostering the acquisition of clinical competencies in terms of study strategies that are more oriented towards clinical practice, longer study time, greater clinical proficiency, and more realistic self-assessment.

MATERIAL AND METHODS

After a clinical course in periodontology, 72 third year dental students were assessed summatively, either using a Written Exam or an OSCE (P-OSCE). The students were informed beforehand about the assessment formats. The self-assessed clinical competence, study time and strategies (i.e. practice with a manikin, peers and patient case) were evaluated by means of a questionnaire. After a comprehensive dental care course, all 72 students were assessed by an overall end-of-year OSCE, in which three periodontal stations were included 'measuring pockets', 'educating patients' and 'tracing an X-ray with bone-loss'. The competence of the previous Written Exam group and the P-OSCE group was investigated by determining the mean scores and pass-fail scores of three periodontal test-stations as well as the total score of the end-of-year OSCE. The degree of realistic self-assessment was studied by correlating the self-assessed competencies as evaluated by means of the questionnaire with the total score of the end-of-year OSCE.

RESULTS

Self-assessed clinical competence, study time and study strategies showed no differences between the P-OSCE and the Written Exam-group. The clinical competence determined in the test-station 'measuring pockets' in the end of year overall OSCE was higher for the P-OSCE group (P = 0.05) when compared with the Written Exam group; the two groups performed equally well in the test station 'educating patients', whereas the performance in 'tracing an X-ray with bone-loss' was better in the Written Exam group. This group also had a higher total score in the end-of-year OSCE (P = 0.05). The degree of realistic self-assessment was higher in the P-OSCE group than in the Written Exam group: in the P-OSCE group the self-assessed clinical competencies correlated significantly with the total score of the overall end-of-year OSCE (P < or = 0.05).

CONCLUSIONS

No effects of the implementation of an OSCE in undergraduate periodontal education were observed in study strategies, but the implementation of an OSCE in undergraduate periodontal education appears to stimulate learning, resulting in greater achievement of specific clinical competence and a greater level of realistic self-assessment.

Student attitudes towards communication skills training in a medical college in Western Nepal

CONTEXT

Previous studies have shown that students have both positive and negative attitudes towards communication skills training. However, studies in Nepal are lacking.

OBJECTIVES

The present study was carried out to determine the positive and negative attitudes of student respondents using the previously validated communication skills attitude scale (CSAS) (see Appendix).

METHODS

The study was carried out among third- and fourth-semester students at the Manipal College of Medical Sciences, Pokhara, Nepal. These students are in the pre-clinical part of their course and learn the basic science subjects through an integrated, system-based curriculum. Gender, age, nationality of the respondents, occupation of parents, medium of instruction at school, attitude towards communication skills training during the clinical years, and self-rating of communication abilities were recorded. Association of the positive and negative attitudes with these variables was determined using appropriate statistical tests (p < 0.05).

FINDINGS

A total of 123 students participated in the study; 74 (60.2%) were male, and 104 (84.5%) had studied in English-medium schools. The median positive attitude score was 51 (inter-quartile range 7). Nationality and attitude towards communication skills training during the clinical years showed a significant association. The mean negative attitude scale score was 31.18 (SD = 4.96). A significant association was noted with attitude towards communication skills training during the clinical years. Both scales range from 13-65, with higher scores indicating stronger attitudes.

CONCLUSIONS

Communication skills training should be modified and strengthened. Formal courses during the clinical years are required. Training sessions for the faculty and further studies across different semesters and in different medical colleges in Nepal are needed.

Effect of ethnicity and gender on performance in undergraduate medical examinations

OBJECTIVE

To assess the effect of ethnicity and gender on medical student examination performance.

DESIGN

Cohort study of Year 3 medical students in 2002 and 2003.

SETTING

Royal Free and University College Medical School, Imperial College School of Medicine.

SUBJECTS

A total of 1216 Year 3 medical students, of whom 528 were male and 688 female, and 737 were white European and 479 Asian.

OUTCOME MEASURE

Performance in summative written and objective structured clinical examinations (OSCEs) in July 2002 and 2003.

RESULTS

White females performed best in all OSCEs and in 3 out of 4 written examinations. Mean scores for each OSCE and 2 out of 4 written examinations were higher for white students than for Asian students. The overall size of the effect is relatively small, being around 1-2%.

CONCLUSION

Students of Asian origin, of both genders, educated in the UK, using English as their first language, continue to perform less well in OSCEs and written assessments than their white European peers.

Comparing self-reported communication skills of medical students in traditional and integrated curricula: a nationwide study

OBJECTIVES

To investigate medical students' self-assessments of their communication skills through medical school related to background factors, curriculum design and perceived medical school stress.

METHODS

Medical students at all year levels attending Norwegian universities in the spring of 2003 were mailed the Oslo Inventory of Self-reported Communication Skills (OSISCS) developed by the authors. Of the total number of students (N=3055), 60% responded. One school had a traditional curriculum, the other three ran integrated models.

RESULTS

Students assessed their instrumental communication skills to increase linearly year by year, while the relational skills showed a curve-linear trajectory reaching the optimum level half-way into the curriculum. Students attending the traditional school reported lower levels of instrumental skills compared to the students from the integrated schools. In relational skills, a similar difference was maintained half-way into the curriculum, but disappeared towards the end. Perceived medical school stress correlated to the self-reported end point levels of the two types of communication skills.

DISCUSSION

The trajectories of self-reported instrumental and relational skills indicate significant variations in facilitating mechanisms between curricula, cognitive processing and perceived medical school stress.

CONCLUSIONS

Self-reported instrumental and relational communication skills develop differently in medical students over the years according to the type of curriculum.

PRACTICE IMPLICATIONS

Curricula should be evaluated for improvement implementations.