Research in medical education: three decades of progress

Stress and value: the student perspective on utilizing real vs. actor patients in objective structured clinical examinations

BACKGROUND

Studies have shown objective structured clinical examinations (OSCEs) to be one of the most reliable tools in assessing clinical performance; however in Pediatrics they primarily use manikins, simulators or parent actors which limits the comprehensiveness of the assessment. In our Pediatric Clerkship, medical students are evaluated using a standardized rubric during a clinical evaluation exercise (CEX) with real patients. This study assessed medical students' perceived stress levels and the educational value of the CEX compared an OSCE. We hypothesized there would be equal stress and value for students with the CEX experience compared to the OSCE.

METHODS

Third year students anonymously completed questionnaires after required Pediatric CEX and Internal Medicine OSCE evaluations from July 2016-June 2017. The questionnaire included questions from the Intrinsic Motivation Inventory, a validated tool used to assess feelings of stress and perceived value of an exercise.

RESULTS

A total of 147 and 145 questionnaires were completed after the CEX and OSCE. There were no differences between groups regarding levels of "nervousness" (p = 0.543) and "relaxation" (p = 0.055); students felt more "at ease" (p = 0.002) and less "pressure" (p < 0.001) during the CEX. Students perceived the CEX to be more useful and important to improve skills compared to the OSCE for the history taking, physical exam and interpersonal skills.

CONCLUSIONS

Our results indicate that the CEX was associated with lower stress levels and had higher perceived value when compared to the OSCE. This study supports the usefulness of incorporating real patients into the clinical evaluation of medical students.

Towards a flexible and personalised development of veterinarians and veterinary nurses working in a companion animal referral care setting

In the Netherlands, the demand for veterinarians and veterinary nurses (VNs) working within referral care is rapidly growing and currently exceeds the amount of available board-certified specialists. Simultaneously, a transparent structure to guide training and development and to assess quality of non-specialist veterinarians and VNs working in a referral setting is lacking. In response, we developed learning pathways guided by an entrustable professional activity (EPA) framework and programmatic assessment to support personalised development and competence of veterinarians and VNs working in referral settings. Between 4 and 35 EPAs varying per discipline (n = 11) were developed. To date, 20 trainees across five disciplines have been entrusted. Trainees from these learning pathways have proceeded to acquire new EPAs in addition to their already entrusted set of EPAs or progressed to specialist training during (n = 3) or after successfully completing (n = 1) the learning pathway. Due to their outcome-based approach, the learning pathways support flexible ways of development.

Assessing the Landscape in Medical Education Literature in Medical Oncology: A Scoping Review

PURPOSE

Medical oncology and medical education (ME) have both expanded exponentially over the past 50 years; thus, it is important to understand the current status of postgraduate medical oncology education and develop ways to advance this field. This study undertakes a scoping review of ME literature in medical oncology to inform future scholarship in this area.

METHODS

MEDLINE, Embase, ERIC, and Web of Science were searched to find peer-reviewed English language articles on postgraduate ME in medical oncology published from 2009 to 2020. Established scoping review methodologies were used in study design; articles were classified by specialty, learner training level, region of authorship, institution type, year of publication, journal type, study methodology, and research topic. Curriculum intervention, scholarship, and domain(s) of physician competency were also assessed. The results were interpreted using descriptive statistics and collated using predetermined conceptual frameworks.

RESULTS

A total of 2,959 references were initially found across four databases. After title and abstract screening, 305 articles remained; after full-text review, 144 articles were included in final analysis. Postgraduate medical oncology education research is increasing, with the majority of articles published in North America. Quantitative studies were most common, primarily survey approaches. For physician competencies, professionalism and medical expertise comprised the large majority of article focuses, whereas very few articles addressed leadership or health advocacy. Curriculum development, professional development, and communication skills were dominant research themes while no articles discussed teacher training.

CONCLUSION

Although areas such as professionalism and communication skills are well-studied, medical oncology ME research is lacking in leadership, health advocacy, and teacher training. This study provides valuable guidance for future ME research in medical oncology and establishes a benchmark to examine changes in educational scholarship over time.

What's been trending with OSCEs in pharmacy education over the last 20 years? A bibliometric review and content analysis

BACKGROUND

Objective structured clinical examinations (OSCEs) remain an integral part of pharmacy education. This study aimed to characterize key researchers, areas, and themes in pharmacy education OSCEs using a bibliometric review with content analysis.

METHODS

A bibliometric review was conducted on literature from over 23 years from January 2000 to May 2023. Articles focusing on any type of OSCE research in pharmacy education in both undergraduate and postgraduate sectors were included. Articles were excluded if they were not original articles or not published in English. A summative content analysis was also conducted to identify key topics.

RESULTS

A total of 192 articles were included in the analysis. There were 242 institutions that contributed to the OSCE literature in pharmacy education, with the leading country being Canada. Most OSCE research came from developed countries and were descriptive studies based on single institution data. The top themes emerging from content analysis were student perceptions on OSCE station styles (n = 98), staff perception (n = 19), grade assessment of OSCEs (n = 145), interprofessional education (n = 11), standardized patients (n = 12), and rubric development and standard setting (n = 8).

IMPLICATIONS

There has been a growth in virtual OSCEs, interprofessional OSCEs, and artificial intelligence OSCEs. Communication rubrics and minimizing assessor variability are still trending research areas. There is scope to conduct more research on evaluating specific types of OSCEs, when best to hold an OSCE, and comparing OSCEs to other assessments.

Early formative objective structured clinical examinations for students in the pre-clinical years of medical education: A non-randomized controlled prospective pilot study

BACKGROUND

The value of formative objective structured clinical examinations (OSCEs) during the pre-clinical years of medical education remains unclear. We aimed to assess the effectiveness of a formative OSCE program for medical students in their pre-clinical years on subsequent performance in summative OSCE.

METHODS

We conducted a non-randomized controlled prospective pilot study that included all medical students from the last year of the pre-clinical cycle of the Université Paris-Cité Medical School, France, in 2021. The intervention group received the formative OSCE program, which consisted of four OSCE sessions, followed by debriefing and feedback, whereas the control group received the standard teaching program. The main objective of this formative OSCE program was to develop skills in taking a structured medical history and communication. All participants took a final summative OSCE. The primary endpoint was the summative OSCE mark in each group. A questionnaire was also administered to the intervention-group students to collect their feedback. A qualitative analysis, using a convenience sample, was conducted by gathering data pertaining to the process through on-site participative observation of the formative OSCE program.

RESULTS

Twenty students were included in the intervention group; 776 in the control group. We observed a significant improvement with each successive formative OSCE session in communication skills and in taking a structured medical history (p<0.0001 for both skills). Students from the intervention group performed better in a summative OSCE that assessed the structuring of a medical history (median mark 16/20, IQR [15; 17] versus 14/20, [13; 16], respectively, p = 0.012). Adjusted analyses gave similar results. The students from the intervention group reported a feeling of improved competence and a reduced level of stress at the time of the evaluation, supported by the qualitative data showing the benefits of the formative sessions.

CONCLUSION

Our findings suggest that an early formative OSCE program is suitable for the pre-clinical years of medical education and is associated with improved student performance in domains targeted by the program.

Learning journeys - student learning development in the first years of a medical degree: an analysis of student conversations

Introduction

Students starting medical school generally come from a learning background that expects them to learn content, which is reproduced to pass an exam. As a part of their learning development, they must adapt and become self-motivated learners who can determine the underlying principles or concepts and use these to problem solve in the uncertainty of real-life clinical practice. Whilst much has been written about designing curricula to promote learning development, there is no one-size fits all approach to facilitating this type of learning, thus an analysis of what helps and hinders learning development is indicated.

Methods

Student pairs in Y2 and Y3 of an undergraduate Bachelor of Medicine, Bachelor of Surgery (BMBS) programme of a South-West UK medical school, were asked to audio record a conversation about their learning through a facilitated problem-based learning approach during the BMBS course so far. They were provided with a brief to aid them in their discussion in the style of the outside broadcast method of BBC Radio 4s listening project. Using this method, the conversation was unfacilitated and allowed to take its natural course. Conversations were transcribed and coded to determine emerging themes with respect to the developing understanding of the students about what and how they were learning.

Results

Four student pairs volunteered for the project one from Y2 and three from Y3. Five key themes were identified including: from 'learning it all, to structured learning'; 'developing understanding and the spiral curriculum'; 'working alone versus working with others'; 'integrated learning and understanding context' and 'assessment and resources.' Narrative analysis within these themes suggested that over the course of the first two to three years of study, participants developed a better understanding of how best to learn, although there were differences in both time and order that participants reached a point where learning felt more natural to them.

Discussion

Analysis of the data suggested that students develop independently towards being self-motivated lifelong learners. There were several key aspects of curriculum design that could be used to facilitate this development, which could easily be incorporated into developing or creating problem- / enquiry-based curricula.

Veterinary Students' Sense of Belonging: Growing Community with Small Group Academic Enhancement

A student's sense of belonging to a university is associated with success in academic setting, happiness, and satisfaction. It is therefore unsurprising that universities commonly strive to improve student measures of belonging especially considering its negative correlation with attrition rates. This study documents the implementation and assessment of a new curricular intervention at Ross University School of Veterinary Medicine (RUSVM) and measures associated changes in students' feeling of belonging to the university and accountability for their success. Specifically, small, group, faculty-guided weekly discussion sessions were introduced to the Veterinary Professional Foundation (VPF) course to complement a series of updated didactic only lectures. Voluntary surveys ("belonging to the university scale" [1] and the "personal accountability in education scale" [2]) were utilized to document student attitudes and feelings surrounding these variables. Likert scores from a control group of students who completed the VPF course prior to the curricular change were compared to the intervention group who engaged in the weekly guided discussion sessions via a Wilcoxon test. The intervention group reported significantly improved feelings of belonging to the university (p-values ranging from 0.008 to 0.027). Minimal change was noted between groups associated with accountability. The addition of weekly small group meetings has proven valuable at RUSVM in improving student sense of belonging to the university. Further research is indicated to determine if accountability may be improved over a longer period of monitoring with continued interventions.

Formative Objective Structured Clinical Examinations (OSCEs) as an Assessment Tool in UK Undergraduate Medical Education: A Review of Its Utility

The Objective Structured Clinical Examination (OSCE) is a globally established clinical examination; it is often considered the gold standard in evaluating clinical competence within medicine and other healthcare professionals' educations alike. The OSCE consists of a circuit of multiple stations testing a multitude of clinical competencies expected of undergraduate students at certain levels throughout training. Despite its widespread use, the evidence regarding formative renditions of the examination in medical training is highly variable; thus, its suitability as an assessment has been challenged for various reasons. Classically, Van Der Vleuten's formula of utility has been adopted in the appraisal of assessment methods as means of testing, including the OSCE. This review aims to provide a comprehensive overview of the literature surrounding the formative use of OSCEs in undergraduate medical training, whilst specifically focusing on the constituents of the equation and means of mitigating factors that compromise its objectivity.

Video Commentary & Machine Learning: Tell Me What You See, I Tell You Who You Are

BACKGROUND & OBJECTIVE

Teaching and assessment of complex problem solving are a challenge for medical education. Integrating Machine Learning (ML) into medical education has the potential to revolutionize teaching and assessment of these problem-solving processes. In order to demonstrate possible applications of ML to education, we sought to apply ML in the context of a structured Video Commentary (VC) assessment, using ML to predict residents' training level.

SETTING

A secondary analysis of multi-institutional, IRB approved study. Participants had completed the VC assessment consisting of 13 short (20-40 seconds) operative video clips. They were scored in real-time using an extensive checklist by an experienced proctor in the assessment. A ML model was developed using TensorFlow and Keras. The individual scores of the 13 video clips from the VC assessment were used as the inputs for the ML model as well as for regression analysis.

PARTICIPANTS

A total of 81 surgical residents of all postgraduate years (PGY) 1-5 from 7 institutions constituted the study sample.

RESULTS

Scores from individual VC clips were strongly positively correlated with PGY level (p = 0.001). Some video clips were identified to be strongly correlated with a higher total score on the assessment; others had significant influence when used to predict trainees' PGY levels. Using a supervised machine learning model to predict trainees' PGY resulted in a 40% improvement over traditional statistical analysis.

CONCLUSIONS

Performing better in a few select video clips was key to obtaining a higher total score but not necessarily foretelling of a higher PGY level. The use of the total score as a sole measure may fail to detect deeper relationships. Our ML model is a promising tool in gauging learners' levels on an assessment as extensive as VC. The model managed to approximate residents' PGY levels with a lower MAE than using traditional statistics. Further investigations with larger datasets are needed.

Academics' Experiences in Veterinary Educational Research: Results of an International Survey

Research conducted by the veterinary education community is critical to continual improvement of educational outcomes. Additionally, research productivity is one metric in promotion and tenure decisions. We sought to identify challenges encountered or anticipated when undertaking or planning veterinary educational research (VER), to learn how these challenges might be overcome, and to synthesize tips for success from those who have performed VER. A branching survey was developed and deployed along the authors' worldwide veterinary education contacts in a cascading manner. The survey collected quantitative and qualitative information from participants who had performed VER and those who planned to perform VER in the future. The 258 participants represented 41 countries. Of the participants, 204 had performed VER (79%) and 54 planned to in the future (21%). The median time spent teaching was 14 years, and median time performing VER was 5 years. The most commonly reported challenges in performing VER were lack of funding, lack of time, and difficulties encountered when undertaking a study, including data collection, analysis, and publishing. When asked about overcoming the challenges, a major theme emerged around people, who provided expertise and mentoring. The most commonly reported tip for success was collaboration; 73% of experienced researchers reported people as most helpful upon beginning VER. Collaborators provided diverse help with ideas, study design, statistics, and other aspects. These results suggest that institutions can offer support to academics in the form of small grants, protected research time, writing workshops, and mentorship to assist with the production of meaningful VER.

Sex Differences in Symptom Phenotypes Among Older Patients with Acute Myocardial Infarction

BACKGROUND

Clinicians make a medical diagnosis by recognizing diagnostic possibilities, often using memories of prior examples. These memories, called "exemplars," reflect specific symptom combinations in individual patients, yet most clinical studies report how symptoms aggregate in populations. We studied how symptoms of acute myocardial infarction combine in individuals as symptom phenotypes and how symptom phenotypes are distributed in women and men.

METHODS

In this analysis of the SILVER-AMI Study, we studied 3041 patients (1346 women and 1645 men) 75 years of age or older with acute myocardial infarction. Each patient had a standardized in-person interview during the acute myocardial infarction admission to document the presenting symptoms, which enabled a thorough examination of symptom combinations in individuals. Specific symptom combinations defined symptom phenotypes and distributions of symptom phenotypes were compared in women and men using Monte Carlo permutation testing and repeated subsampling.

RESULTS

There were 1469 unique symptom phenotypes in the entire SILVER-AMI cohort of patients with acute myocardial infarction. There were 831 unique symptom phenotypes in women, as compared with 819 in men, which was highly significant, given the larger number of men than women in the study (P < .0001). Women had significantly more symptom phenotypes than men in almost all acute myocardial infarction subgroups.

CONCLUSIONS

Older patients with acute myocardial infarction have enormous variation in symptom phenotypes. Women reported more symptoms and had significantly more symptom phenotypes than men. Appreciation of the diversity of symptom phenotypes may help clinicians recognize the less common phenotypes that occur more often in women.

Diagnostic reasoning in cardiovascular medicine

Research in cognitive psychology shows that expert clinicians make a medical diagnosis through a two step process of hypothesis generation and hypothesis testing. Experts generate a list of possible diagnoses quickly and intuitively, drawing on previous experience. Experts remember specific examples of various disease categories as exemplars, which enables rapid access to diagnostic possibilities and gives them an intuitive sense of the base rates of various diagnoses. After generating diagnostic hypotheses, clinicians then test the hypotheses and subjectively estimate the probability of each diagnostic possibility by using a heuristic called anchoring and adjusting. Although both novices and experts use this two step diagnostic process, experts distinguish themselves as better diagnosticians through their ability to mobilize experiential knowledge in a manner that is content specific. Experience is clearly the best teacher, but some educational strategies have been shown to modestly improve diagnostic accuracy. Increased knowledge about the cognitive psychology of the diagnostic process and the pitfalls inherent in the process may inform clinical teachers and help learners and clinicians to improve the accuracy of diagnostic reasoning. This article reviews the literature on the cognitive psychology of diagnostic reasoning in the context of cardiovascular disease.

Rethinking implementation science for health professions education: A manifesto for change

Implementation science approaches the challenges of translating evidence into practice as a matter of scientific inquiry. This conceptual paper uses an implementation science lens to examine the ways in which evidence from health professions education research is brought to bear on decision-making. The authors describe different decision-making contexts and the kinds of evidence they consider, and from this, they outline ways in which research findings might be better presented to support their translation into policy and practice. Reflecting on the nature of decision-making in health professions education and how decisions are made and then implemented in different health professions education contexts, the authors argue that researchers should align their work with the decision-making contexts that are most likely to make use of them. These recommendations reflect implementation science principles of packaging and disseminating evidence in ways that are meaningful for key stakeholders, that stem from co-creation of knowledge, that require or result in meaningful partnerships, and that are context specific and relevant.

Impact of integrating objective structured clinical examination into academic student assessment: Large-scale experience in a French medical school

Purpose

Objective structured clinical examinations (OSCE) evaluate clinical reasoning, communication skills, and interpersonal behavior during medical education. In France, clinical training has long relied on bedside clinical practice in academic hospitals. The need for a simulated teaching environment has recently emerged, due to the increasing number of students admitted to medical schools, and the necessity of objectively evaluating practical skills. This study aimed at investigating the relationships between OSCE grades and current evaluation modalities.

Methods

Three-hundred seventy-nine 4^th-year students of University-of-Paris Medical School participated to the first large-scale OSCE at this institution, consisting in three OSCE stations (OSCE#1–3). OSCE#1 and #2 focused on cardiovascular clinical skills and competence, whereas OSCE#3 focused on relational skills while providing explanations before planned cholecystectomy. We investigated correlations of OSCE grades with multiple choice (MCQ)-based written examinations and evaluations of clinical skills and behavior (during hospital traineeships); OSCE grade distribution; and the impact of integrating OSCE grades into the current evaluation in terms of student ranking.

Results

The competence-oriented OSCE#1 and OSCE#2 grades correlated only with MCQ grades (r = 0.19, P<0.001) or traineeship skill grades (r = 0.17, P = 0.001), respectively, and not with traineeship behavior grades (P>0.75). Conversely, the behavior-oriented OSCE#3 grades correlated with traineeship skill and behavior grades (r = 0.19, P<0.001, and r = 0.12, P = 0.032), but not with MCQ grades (P = 0.09). The dispersion of OSCE grades was wider than for MCQ examinations (P<0.001). When OSCE grades were integrated to the final fourth-year grade with an incremental 10%, 20% or 40% coefficient, an increasing proportion of the 379 students had a ranking variation by ±50 ranks (P<0.001). This ranking change mainly affected students among the mid-50% of ranking.

Conclusion

This large-scale French experience showed that OSCE designed to assess a combination of clinical competence and behavioral skills, increases the discriminatory capacity of current evaluations modalities in French medical schools.

Where we've come from, where we might go

The paper reviews 50 years of research in health sciences education and identifies several recurring controversies-formative versus summative assessment, high and low fidelity simulation, expertise as knowledge versus skills, and the impact of teaching versus curriculum. I then look at the role these may play in the current situation where COVID has necessitated rapid change to distance learning. I then posit an essential role for research in teaching and learning, using multiple methods from qualitative to neuropsychological to better understand the dimensions of effective teaching. The ultimate goal is to operationalize these findings in creation of distance learning modules.

Healthcare systems and the sciences of health professional education

Health professions education is that part of the education system which applies educational philosophy, theory, principles and practice in a complex relationship with busy clinical services, where education is not the primary role. While the goals are clear-to produce the health workforce that society needs to improve health outcomes-both education and healthcare systems continue to evolve concurrently amidst changes in knowledge, skills, population demographics and social contracts. In observing a significant anniversary of this journal, which sits at the junction of education and healthcare systems, it is appropriate to reflect on how the relationship is evolving. Health professions educators must listen to the voices of regulators, employers, students and patients when adapting to new service delivery models that emerge in response to pressures for change. The recent COVID-19 pandemic is one example of disruptive change, but other factors, such as population pressures and climate change, can also drive innovations that result in lasting change. Emerging technology may act as either a servant of change or a disruptor. There is a pressing need for interdisciplinary research that develops a theory and evidence base to strengthen sustainability of change.

Clinical assessors' working conceptualisations of undergraduate consultation skills: a framework analysis of how assessors make expert judgements in practice

Undergraduate clinical assessors make expert, multifaceted judgements of consultation skills in concert with medical school OSCE grading rubrics. Assessors are not cognitive machines: their judgements are made in the light of prior experience and social interactions with students. It is important to understand assessors' working conceptualisations of consultation skills and whether they could be used to develop assessment tools for undergraduate assessment. To identify any working conceptualisations that assessors use while assessing undergraduate medical students' consultation skills and develop assessment tools based on assessors' working conceptualisations and natural language for undergraduate consultation skills. In semi-structured interviews, 12 experienced assessors from a UK medical school populated a blank assessment scale with personally meaningful descriptors while describing how they made judgements of students' consultation skills (at exit standard). A two-step iterative thematic framework analysis was performed drawing on constructionism and interactionism. Five domains were found within working conceptualisations of consultation skills: Application of knowledge; Manner with patients; Getting it done; Safety; and Overall impression. Three mechanisms of judgement about student behaviour were identified: observations, inferences and feelings. Assessment tools drawing on participants' conceptualisations and natural language were generated, including 'grade descriptors' for common conceptualisations in each domain by mechanism of judgement and matched to grading rubrics of Fail, Borderline, Pass, Very good. Utilising working conceptualisations to develop assessment tools is feasible and potentially useful. Work is needed to test impact on assessment quality.

A randomised controlled pilot trial of the influence of non-native English accents on examiners' scores in OSCEs

BACKGROUND

Objective structured clinical examinations (OSCEs) are important aspects of assessment in medical education. There is anecdotal evidence suggesting that students with non-native English accents (NNEA) may be subjected to unconscious bias. It is imperative to minimise the examiners' bias so that the difference in the scores reflects students' clinical competence. Research shows NNEAs can cause stereotyping, often leading to the speaker being negatively judged. However, no medical education study has looked at the influence of NNEAs in assessment.

METHODS

This is a randomized, single-blinded controlled trial. Four videos of one mock OSCE station were produced. A professional actor played a medical student. Two near identical scripts were prepared. Two videos showed the actor speaking with an Indian accent and two videos showed the actor speaking without the accent in either script. Forty-two OSCE examiners in the United Kingdom (UK) were recruited and randomly assigned to two groups. They watched two videos online, each with either script, each with a different script. One video with a NNEA and one video was without. Checklist item scores were analysed with descriptive statistics and non-parametric independent samples median test. Global scores were analysed with descriptive statistics and Mann-Whitney test.

RESULTS

Thirty-two examiners completed the study. The average scores for the checklist items (41.6 points) did not change when the accent variable was changed. Independent samples median test showed no statistically significant relationship between the accent and the scores (p = 0.787). For the global scores received by the videos with the NNEA, there were one less 'Good' grade and one more 'Fail' grade compared to those without the NNEA. Mann-Whitney test on global score showed lower scores for videos with NNEA (p = 0.661).

CONCLUSIONS

Examiners were not biased either positively or negatively towards NNEAs when providing checklist or global scores. Further study is required to validate the findings of this study. More discussion is warranted to consider how the accent should be considered in current medical education assessment.

REGISTRATION

Trial registration completed trial, ID: ISRCTN17360102, Retrospectively registered on 15/04/2020.

Simulation-based training and assessment of mobile pre-hospital SARS-CoV-2 diagnostic teams in Styria, Austria

The World Health Organization has declared coronavirus disease 2019 (COVID-19) a pandemic. Polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the diagnostic gold standard of COVID-19. We have developed a simulation-based training program for mobile prehospital diagnostic teams in the province of Styria, Austria, and performed a prospective observational study on its applicability and effectivity.The 1-day curriculum uses theoretical instruction, technical skills training, and simulator-based algorithm training to teach and train prehospital patient identification and communication, donning the personal protective equipment, collection of naso-/oropharyngeal swabs for SARS-CoV-2 polymerase chain reaction testing, doffing the personal protective equipment, and sample logistics. Trainings were conducted at the SIM CAMPUS simulation hospital, Eisenerz, using high-fidelity patient simulation. To ensure achievement of predefined learning outcomes, participants had to undergo a final simulator-based objective structured clinical examination.In March 2020, 45 emergency medical assistants and 1 physician of the Austrian Red Cross participated on a voluntary basis. Forty-five of the 46 participants (97.8%) completed the curriculum successfully, with mean objective structured clinical examination ratings of 98.6%.Using several proven educational concepts, we have successfully drafted and implemented a training program for mobile prehospital SARS-CoV-2 diagnostic teams. Based on simulation-based objective structured examinations, it has prepared participants effectively for preclinical duties.

Do it together! Conception and long-term results of the trans-institutional Master of Medical Education (MME) program in Germany

Medical education has the responsibility to react to developments and changing demands in healthcare. This implies the need for experts in the area of medical education as well as nationally coordinated initiatives. An innovative model based on trans-institutional cooperation and nationwide consensus for establishing a master's degree course in Medical Education (MME) and long-term results are presented here to other countries and other programs, facing similar challenges. A MME program with the following goals was implemented at the Medical Faculty of Heidelberg University, Germany, in 2004: Qualification of leaders in medical faculties, professionalization and improvement of teaching quality, promotion of nationwide and international exchange, and stimulation of research in medical education. Since then, 15 cohorts with a total of 380 participants have started their studies, 179 participants have graduated and 90 publications resulted from the master's theses (as at November 2018). Evaluation and survey data revealed a very high degree of satisfaction among the participants and a lasting development to medical education experts. Our concept shows that the bundling of regional expertise into a clearly structured trans-institutional network can be a driving force for nationwide comprehensive changes, in order to address changing demands in healthcare systems and transfer it into medical education programs.

A scoping review of medical education research for residents in radiation oncology

BACKGROUND

Both medical education and radiation oncology have progressed significantly in the past decade, but a generalized overview of educational research for radiation oncology residents has not been produced. This study examines recent research trends in medical education for residents in radiation oncology through a scoping review.

METHODS

We conducted a scoping review of medical education research for residents in radiation oncology to survey the research trends. We used publications available on MEDLINE, PubMed, and Scopus to conduct this scoping review.

RESULTS

We screened 221 full-text articles, 146 of which met our inclusion criteria. These publications showed increased activity in medical education research for residents, most involving affiliations in the United States. We identified persistent interest in training-, contouring-, and technology-related issues. An increase in research related to career, treatment quality, and multidisciplinary training was also observed. However, no research about teacher training was identified.

CONCLUSIONS

This scoping review presents the trends in study interests among stakeholders of medical education research in radiation oncology. With an investigation of existing studies, this research identifies areas of high priority and a lack of studies about teacher training. This study provides potential future directions for medical education research for residents in radiation oncology.

Do it together! Conception and long-term results of the trans-institutional Master of Medical Education (MME) program in Germany

Medical education has the responsibility to react to developments and changing demands in healthcare. This implies the need for experts in the area of medical education as well as nationally coordinated initiatives. An innovative model based on trans-institutional cooperation and nationwide consensus for establishing a master's degree course in Medical Education (MME) and long-term results are presented here to other countries and other programs, facing similar challenges. A MME program with the following goals was implemented at the Medical Faculty of Heidelberg University, Germany, in 2004: Qualification of leaders in medical faculties, professionalization and improvement of teaching quality, promotion of nationwide and international exchange, and stimulation of research in medical education. Since then, 15 cohorts with a total of 380 participants have started their studies, 179 participants have graduated and 90 publications resulted from the master's theses (as at November 2018). Evaluation and survey data revealed a very high degree of satisfaction among the participants and a lasting development to medical education experts. Our concept shows that the bundling of regional expertise into a clearly structured trans-institutional network can be a driving force for nationwide comprehensive changes, in order to address changing demands in healthcare systems and transfer it into medical education programs.

Between fairness and fear-Dental undergraduates' attitudes towards objective structured clinical examinations

INTRODUCTION

Objective structured clinical examinations (OSCEs) are an established method of assessment for dental undergraduates. There is little published dental education research exploring the views of undergraduates towards OSCEs.

AIM

To explore and describe the views of dental undergraduates towards OSCEs.

METHOD

A sequential mixed methods design was applied. This included a cross-sectional survey of all 204 dental undergraduates in Years 2, 3 and 4 within a UK dental school using an anonymous self-report online questionnaire (response rate 57%), which was followed by two focus group interviews of n = 10 Year-2 students.

RESULTS

Most students gave positive views regarding the OSCE form of assessment. Questionnaire data highlighted that students felt that the OSCE tested their diagnostic, clinical and communication skills, and covered a wide range of skills and disciplines. Students also generally saw them as a useful educational exercise that went beyond testing recall of facts. Most students thought that the OSCEs were "fair" assessments. Negative views focused around student lack of preparation for them, especially in earlier years. Focus group data explored further these concerns but also emphasised the need for more student-centred support pre-OSCE.

CONCLUSION

Objective structured clinical examinations can be an anxiety-inspiring form of assessment for students in the early years of the programme. Dental educators need to be more aware of these concerns to develop strategies to increase student preparedness for OSCEs without increasing stress.

Limited by our limitations

Study limitations represent weaknesses within a research design that may influence outcomes and conclusions of the research. Researchers have an obligation to the academic community to present complete and honest limitations of a presented study. Too often, authors use generic descriptions to describe study limitations. Including redundant or irrelevant limitations is an ineffective use of the already limited word count. A meaningful presentation of study limitations should describe the potential limitation, explain the implication of the limitation, provide possible alternative approaches, and describe steps taken to mitigate the limitation. This includes placing research findings within their proper context to ensure readers do not overemphasize or minimize findings. A more complete presentation will enrich the readers' understanding of the study's limitations and support future investigation.

A Scoping Review of Medical Education Research in Neurosurgery

BACKGROUND

Little is known about the state of medical education (ME) research in neurosurgery. As ME started to develop in neurosurgery in recent years, it is important to understand the current status and develop the theory for advancement in neurosurgery. The aim of this study was to undertake a scoping review of neurosurgery literature on ME research.

METHODS

MEDLINE, SCOPUS, and PubMed databases were searched. Inclusion criteria were full-text articles in English published from January 2006 to December 2017. Research aspects included country of publication, annual number of publications, journal types, type of participants, frequently researched topics, and research design. Search terms included neurosurgery, medical education, teaching, training, learning, and curriculum.

RESULTS

A total of 9863 references were found across 3 databases. After duplicate removal and further screening, 533 references remained for coding analysis. ME research activity in neurosurgery is increasing and commonly observed in Western countries. Identified articles were mostly quantitative, with curriculum, assessment (especially simulation), and teaching and learning being the most dominant research themes.

CONCLUSIONS

This study highlights the need for enhanced quantity and quality of ME research in neurosurgery. It identifies areas of highest priority and aspects to be improved and provides us with a rationale for future development in ME in neurosurgery. These findings reveal future education research direction and programmatic research areas, while also establishing a benchmark to assess changes in educational scholarship over time.

Scientism in Medical Education and the Improvement of Medical Care: Opioids, Competencies, and Social Accountability

Scientism in medical education distracts educators from focusing on the content of learning; it focuses attention instead on individual achievement and validity in its measurement. I analyze the specific form that scientism takes in medicine and in medical education. The competencies movement attempts to challenge old "scientistic" views of the role of physicians, but in the end it has invited medical educators to focus on validity in the measurement of individual performance for attitudes and skills that medicine resists conceptualizing as objective. Academic medicine should focus its efforts instead on quality and relevance of care. The social accountability movement proposes to shift the focus of academic medicine to the goal of high quality and relevant care in the context of community service and partnership with the institutions that together with medicine create and cope with health and with health deficits. I make the case for this agenda through a discussion of the linked histories of the opioid prescribing crisis and the professionalism movement.

Conceptions of learning factors in postgraduate health sciences master students: a comparative study with non-health science students and between genders

BACKGROUND

The students' conceptions of learning in postgraduate health science master studies are poorly understood. The aim of this study was to compare the factors influencing conceptions of learning in health sciences and non-health sciences students enrolled in postgraduate master programs in order to obtain information that may be useful for students and for future postgraduate programs.

METHODS

A modified version of the Learning Inventory Conception Questionnaire (COLI) was used to compare students' conception learning factors in 131 students at the beginning of their postgraduate studies in health sciences, experimental sciences, arts and humanities and social sciences.

RESULTS

The present study demonstrates that a set of factors may influence conception of learning of health sciences postgraduate students, with learning as gaining information, remembering, using, and understanding information, awareness of duty and social commitment being the most relevant. For these students, learning as a personal change, a process not bound by time or place or even as acquisition of professional competences, are less relevant. According to our results, this profile is not affected by gender differences.

CONCLUSIONS

Our results show that the overall conceptions of learning differ among students of health sciences and non-health sciences (experimental sciences, arts and humanities and social sciences) master postgraduate programs. These finding are potentially useful to foster the learning process of HS students, because if they are metacognitively aware of their own conception or learning, they will be much better equipped to self-regulate their learning behavior in a postgraduate master program in health sciences.

How can systems engineering inform the methods of programme evaluation in health professions education?

CONTEXT

We evaluate programmes in health professions education (HPE) to determine their effectiveness and value. Programme evaluation has evolved from use of reductionist frameworks to those addressing the complex interactions between programme factors. Researchers in HPE have recently suggested a 'holistic programme evaluation' aiming to better describe and understand the implications of 'emergent processes and outcomes'.

FRAMEWORK

We propose a programme evaluation framework informed by principles and tools from systems engineering. Systems engineers conceptualise complexity and emergent elements in unique ways that may complement and extend contemporary programme evaluations in HPE. We demonstrate how the abstract decomposition space (ADS), an engineering knowledge elicitation tool, provides the foundation for a systems engineering informed programme evaluation designed to capture both planned and emergent programme elements.

METHODS

We translate the ADS tool to use education-oriented language, and describe how evaluators can use it to create a programme-specific ADS through iterative refinement. We provide a conceptualisation of emergent elements and an equation that evaluators can use to identify the emergent elements in their programme. Using our framework, evaluators can analyse programmes not as isolated units with planned processes and planned outcomes, but as unfolding, complex interactive systems that will exhibit emergent processes and emergent outcomes. Subsequent analysis of these emergent elements will inform the evaluator as they seek to optimise and improve the programme.

CONCLUSION

Our proposed systems engineering informed programme evaluation framework provides principles and tools for analysing the implications of planned and emergent elements, as well as their potential interactions. We acknowledge that our framework is preliminary and will require application and constant refinement. We suggest that our framework will also advance our understanding of the construct of 'emergence' in HPE research.

Efficacy and Feasibility of Objective Structured Clinical Examination in the Internal Assessment for Surgery Postgraduates

INTRODUCTION

Traditionally assessment in medical training programs has been through subjective faculty evaluations or multiple choice questions. Conventional examinations provide assessment of the global performance rather than individual competencies thus making the final feedback less meaningful. The objective structured clinical examination (OSCE) is a relatively new multidimensional tool for evaluating training. This study was carried out to determine the efficacy and feasibility of OSCE as a tool for the internal assessment of surgery residents.

METHODS

This study was carried out on the marks obtained by surgery residents at different levels of training in a single tertiary center in India over the 4 OSCEs conducted in the years 2015 and 2016. The marks of the OSCE were collected from the departmental records and analyzed. Reliability was calculated using internal consistency using Cronbach's α. Validity was calculated by item total correlation. Content validation was done by obtaining expert reviews from 5 experts using a proforma, to assess the content and checklist of each station of the OSCE.

RESULTS

A total of 49 surgery residents were assessed in small batches during the above mentioned period. Of the 4 OSCEs conducted by us, 3 had a high value of Cronbach's α of greater than 0.9, as opposed to the set standard of 0.7. Out of 23 stations used in the 4 examinations separately, only 3 stations were found to have a low correlation coefficient (item total correlation), and hence, a low validity. The remaining 20 stations were found to have a high validity. Expert review showed unanimous validation of the content of 17 out of the 23 stations, with few suggestions for change in the remaining 6 stations. The material and manpower used was minimal and easy to obtain, thus making the OSCE feasible to conduct.

CONCLUSION

OSCE is a reliable, valid. and feasible method for evaluating surgery residents at various levels of training.

Patterns of Clinical Reasoning in Physical Therapist Students

BACKGROUND AND PURPOSE

Clinical reasoning is a complex, nonlinear problem-solving process that is influenced by models of practice. The development of physical therapists' clinical reasoning abilities is a crucial yet underresearched aspect of entry-level (professional) physical therapist education.

OBJECTIVES

The purpose of this qualitative study was to examine the types of clinical reasoning strategies physical therapist students engage in during a patient encounter.

METHODS

A qualitative descriptive case study design involving within and across case analysis was used. Eight second-year, professional physical therapist students from 2 different programs completed an evaluation and initial intervention for a standardized patient followed by a retrospective think-aloud interview to explicate their reasoning processes. Participants' clinical reasoning strategies were examined using a 2-stage qualitative method of thematic analysis.

RESULTS

Participants demonstrated consistent signs of development of physical therapy-specific reasoning processes, yet varied in their approach to the case and use of reflection. Participants who gave greater attention to patient education and empowerment also demonstrated greater use of reflection-in-action during the patient encounter. One negative case illustrates the variability in the rate at which students may develop these abilities.

CONCLUSIONS

Participants demonstrated development toward physical therapist--specific clinical reasoning, yet demonstrated qualitatively different approaches to the patient encounter. Multiple factors, including the use of reflection-in-action, may enable students to develop greater flexibility in their reasoning processes.

Applicability of Progress Testing in Veterinary Medical Education

A substantial part of graduate education in veterinary medicine is spent in clinical practice. During the clinical experiential phase, it is difficult to monitor students' actual knowledge development: they build individual records of experiences based on the cases they have to deal with, while mainly focusing on knowledge that is of direct, clinical relevance to them. As a result, students' knowledge bases may differ to such a degree that a single test alone may not be able to provide an adequate reflection of progress made. In these circumstances, progress testing, which is a method of longitudinal assessment independent of the curricular structure, may offer a viable solution. The purpose of this study, therefore, was to determine the extent to which progress tests (PT) can be used to monitor progress in knowledge development at a graduate level in veterinary medical education. With a 6-month interval, we administered two tests to students based on the Maastricht Progress Test format that covered a large variety of veterinary topics. Consequently, we analyzed students' progress in knowledge development. Based on a substantive appraisal of the questions and analysis of the test results, we concluded that the tests met the measurement criteria. They appeared sensitive enough to gauge the progress made and were appreciated by the students. Hence, in spite of the differences within the whole graduate group, the PT format can be used to monitor students' knowledge development.

Analysis of educational research at a medical faculty in Germany and suggestions for strategic development - a case study

Background: Evidence-based medical education is playing an increasingly important role in the choice of didactic methods and the development of medical curricula and assessments. In Germany, a growing number of educational research projects has accompanied an ongoing change in the medical education process. The aim of this project was to assess medical education research activities at one medical faculty to develop procedural recommendations for the support and development of best evidence medical education. Methods: Using a newly developed online questionnaire, the 65 institutes and departments of the medical faculty of Hamburg University at Hamburg University Medical-Center (UKE) were asked to report their medical education research and service projects, medical education publications, medical education theses, financial support for educational projects, and supportive structures that they would consider helpful in the future. The data were grouped, and a SWOT analysis was performed. Results: In total, 60 scientists who were involved in 112 medical education research publications between 1998 and 2014 were identified at the UKE. Twenty-five of them had published at least one manuscript as first or last author. Thirty-three UKE institutions were involved in educational service or research projects at the time of the study, and 75.8% of them received internal or external funding. Regular educational research meetings and the acquisition of co-operation partners were mentioned most frequently as beneficial supportive structures for the future. Conclusion: An analysis to define the status quo of medical education research at a medical faculty seems to be a helpful first step for the development of a strategy and structure to further support researchers in medical education.

An experimental study on the effects of a simulation game on students' clinical cognitive skills and motivation

Simulation games are becoming increasingly popular in education, but more insight in their critical design features is needed. This study investigated the effects of fidelity of open patient cases in adjunct to an instructional e-module on students' cognitive skills and motivation. We set up a three-group randomized post-test-only design: a control group working on an e-module; a cases group, combining the e-module with low-fidelity text-based patient cases, and a game group, combining the e-module with a high-fidelity simulation game with the same cases. Participants completed questionnaires on cognitive load and motivation. After a 4-week study period, blinded assessors rated students' cognitive emergency care skills in two mannequin-based scenarios. In total 61 students participated and were assessed; 16 control group students, 20 cases students and 25 game students. Learning time was 2 h longer for the cases and game groups than for the control group. Acquired cognitive skills did not differ between groups. The game group experienced higher intrinsic and germane cognitive load than the cases group (p = 0.03 and 0.01) and felt more engaged (p < 0.001). Students did not profit from working on open cases (in adjunct to an e-module), which nonetheless challenged them to study longer. The e-module appeared to be very effective, while the high-fidelity game, although engaging, probably distracted students and impeded learning. Medical educators designing motivating and effective skills training for novices should align case complexity and fidelity with students' proficiency level. The relation between case-fidelity, motivation and skills development is an important field for further study.

Psychometrics and its discontents: an historical perspective on the discourse of the measurement tradition

Psychometrics has recently undergone extensive criticism within the medical education literature. The use of quantitative measurement using psychometric instruments such as response scales is thought to emphasize a narrow range of relevant learner skills and competencies. Recent reviews and commentaries suggest that a paradigm shift might be presently underway. We argue for caution, in that the psychometrics approach and the quantitative account of competencies that it reflects is based on a rich discussion regarding measurement and scaling that led to the establishment of this paradigm. Rather than reflecting a homogeneous discipline focused on core competencies devoid of consideration of context, the psychometric community has a history of discourse and debate within the field, with an acknowledgement that the techniques and instruments developed within psychometrics are heuristics that must be used pragmatically.

Can disclosure of scoring rubric for basic clinical skills improve objective structured clinical examination?

PURPOSE

To determine whether disclosure of scoring rubric for objective basic clinical skills can improve the scores on the objective structured clinical examination (OSCE) in medical students.

METHODS

Clinical performance score results of one university medical students (study group, n=345) were compared to those of another university (control group, n=1,847). Both groups took identical OSCE exam. OSCE rubric was not revealed to the study group until they were in the last 2 years of medical school.

RESULTS

There was no significant difference between before and after disclosure of rubric. However, history taking and physical examination scores of the study group were lower than those of the control group before the disclosure of rubric. After disclosure of rubric, the scores were either unchanged or slightly increased in the control group. Trend analysis of scores demonstrated that history taking and physical examination scores after the disclosure were significantly increased in the study group for 2 years.

CONCLUSION

This study revealed that disclosure of basic clinical skills rubric to medical students could enhance their clinical performance, particularly in history taking and physical examination scores.

Dental Undergraduate Views of Objective Structured Clinical Examinations (OSCEs): A Literature Review

Objective Structured Clinical Examinations (OSCEs) are widely used in dental undergraduate assessment, often determining progression or graduation. Student evaluation of this assessment process is important, and this includes identifying the views of the student. The aim of this paper is to present a review of the current literature regarding dental student perceptions of OSCEs. A search of the PubMed database covering the period 1975 to 2015 identified 121 possible papers from which only six were suitable for review. The remaining papers were excluded due to them not reporting on dental undergraduate views. Students perceived the OSCE to be a valid assessment in three studies, but not in one. The educational benefit of an OSCE is well supported by these studies. OSCEs can induce high levels of anxiety compared to other forms of assessments, but this did not affect student performance. The majority of students would chose to have a similar format of assessment again, showing support for OSCEs. Further research using larger cohorts of students could be undertaken in order to support these finding which would give added evidence for the continuing use of OSCEs as a valid method of both dental undergraduate education and assessment.

Developing doctors: what are the attitudes and perceptions of year 1 and 2 medical students towards a new integrated formative objective structured clinical examination?

BACKGROUND

Objective Structured Clinical Examination (OSCE) is a core component of undergraduate medical student assessment. With increased emphasis on integrated programmes, more courses include OSCEs in the traditionally 'preclinical' years. The acceptability and impact of such assessment methods at this stage of training is unknown.

METHODS

In 2013 and 2014 University College London Medical School piloted a formative, integrated OSCE in years 1 and 2 of the undergraduate medical degree programme. This study with a sequential exploratory design aimed to explore the acceptability and impact of such an OSCE in the early years of medical school. 1280 students completed the OSCE and were invited to complete a questionnaire exploring their views of the OSCE (response rate 96.6%). Four focus groups, each with five or six participants (22 in total) were subsequently held to further explore themes. Data was independently transcribed and coded using thematic analysis.

RESULTS

Students were strongly in favour of the introduction of an OSCE in addition to existing assessments. Six overarching themes were identified: application of knowledge and skills; OSCE as an experience; OSCE as a process; a learning curve; becoming a doctor; and creating an effective OSCE.

CONCLUSIONS

Results strongly support the role of OSCE early in the medical course with many benefits reported. An OSCE at this stage aligns with the vision of integrated medical education which includes early patient contact and introduction of clinical and professional skills. It also fosters feelings of responsibility and professional identity amongst students.

Research priorities in medical education at Shiraz University of Medical Sciences:categories and subcategories in the Iranian context

INTRODUCTION

Research in education is a globally significant issue without a long history. Due to the importance of the issue in Health System Development programs, this study intended to determine research priorities in medical education, considering their details and functions. By determining barriers existing in research in education progress, it is tried to make research priorities more functional by recommending acceptable strategies.

METHODS

This is a qualitative-descriptive study in two descriptive phases. The goal of these phases was to determine research priorities subcategories in medical education by Nominal Group Technique (NGT) and two rounds of Delphi method. Through the first phase, subcategories of research priorities were determined, using Nominal Group Technique under medical education experts' supervision. Through two rounds of Delphi, a questionnaire was constructed based on the subcategories. Eventually, research priorities were determined based on their highest score (scores more than 7 out of 10).

RESULTS

In the first phase (NGT), 35 priorities in 5 major fields of medical education were presented. In the second phase, priorities were scored, using Delphi method. Medical Ethics and professionalism gained the highest scores (7.63±1.26) and educational evaluation the lowest (7.28±1.52). In this stage, 7 items were omitted but 2 of them were added again after experts' revision in the third round of Delphi.

CONCLUSION

According to the results of the present study and based on previous studies, it really seems that the fields of "Learning and Teaching Approaches" and "Medical Ethics and Professionalism" were more important. Because of financial and resource limitations in our country and the importance of research priorities, it is recommended to frequently study "research priorities determination program" at universities.

Trends in national licensing examinations in medicine

CONTEXT

As a contribution to this special issue commemorating the journal's 50th volume, this paper seeks to explore directions for national licensing examinations (NLEs) in medicine. Increases in the numbers of new medical schools and the mobility of doctors across national borders mean that NLEs are becoming even more important to ensuring physician competence.

OBJECTIVES

The purpose of this paper is to explore the use of NLEs in the future in the context of global changes in medical education and health care delivery.

METHODS

Because the literature related to NLEs is so large, we have not attempted a comprehensive review, but have focused instead on a small number of topics on which we think we have something useful to say. The paper is organised around five predicted trends for NLEs.

DISCUSSION

The first section discusses reasons why we think the use of NLEs will increase in the coming years. The second section discusses the ongoing problem of content specificity and its implications for the design of NLEs. The third section examines the evolution of large-scale, standardised cognitive assessments in NLEs and suggests some future directions. Reflecting the fact that NLEs are, increasingly, attempting to assess more than just knowledge, the fourth section addresses the future of large-scale clinical skills assessments in NLEs, predicting both increases in their use and some shifts in the nature of the stations used. The fifth section discusses workplace-based assessments, predicting increases in their use for formative assessment and identifying some limitations in their direct application in NLEs. The concluding section discusses the cost of NLEs and indulges in some further speculations about their evolution.

Considering Research Outcomes as Essential Tools for Medical Education Decision Making

As medical educators face the challenge of incorporating new content, learning methods, and assessment techniques into the curriculum, the need for rigorous medical education research to guide efficient and effective instructional planning increases. When done properly, well-designed education research can provide guidance for complex education decision making. In this Commentary, the authors consider the 2015 Research in Medical Education (RIME) research and review articles in terms of the critical areas in teaching and learning that they address. The broad categories include (1) assessment (the largest collection of RIME articles, including both feedback from learners and instructors and the reliability of learner assessment), (2) the institution's impact on the learning environment, (3) what can be learned from program evaluation, and (4) emerging issues in faculty development. While the articles in this issue are broad in scope and potential impact, the RIME committee noted few studies of sufficient rigor focusing on areas of diversity and diverse learners. Although challenging to investigate, the authors encourage continuing innovation in research focused on these important areas.

Analysis of the level of general clinical skills of physician assistant students using an objective structured clinical examination

RATIONALE, AIMS AND OBJECTIVES

The physician assistant (PA) is trained to perform clinical tasks traditionally performed by medical doctors (MDs). Previous research showed no difference in the level of clinical skills of PAs compared with MDs in a specific niche, that is the specialty in which they are employed. However, MDs as well as PAs working within a specialty have to be able to recognize medical problems in the full scope of medicine. The objective is to examine PA students' level of general clinical skills across the breadth of clinical cases.

METHOD

A cross-sectional study was conducted. PA students and recently graduated MDs in the Netherlands were observed on their clinical skills by means of an objective structured clinical examination comprising five stations with common medical cases. The level of mastering history taking, physical examination, communication and clinical reasoning of PA students and MDs were described in means and standard deviation. Cohen's d was used to present effect sizes.

RESULTS

PA students and MDs score about equal on history taking (PA 5.8 ± 0.8 vs. MD 5.7 ± 0.7), physical examination (PA 4.8 ± 1.3 vs. MD 5.4 ± 0.8) and communication (PA: 8.2 ± 0.8 vs. MD: 8.6 ± 0.5) in the full scope of medicine. In the quality of the report, including the patient management plan, PA students scored a mean of 6.0 ± 0.6 and MDs 6.8 ± 0.6.

CONCLUSIONS

In this setting in the Netherlands, PA students and MDs score about equal in the appraisal of common cases in medical practice. The slightly lower scores of PA students' clinical reasoning in the full scope of clinical care may have raise attention to medical teams working with PAs and PA training programmes.