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

Formative objective structured clinical examination with immediate feedback improves surgical clerks' self-confidence and clinical competence

OBJECTIVE

Clerkship is crucial for fourth-year medical students before entering the clinical environment. However, lack of confidence impairs clerks' performance during the clinical rotation. We assess the impact of formative Objective Structured Clinical Examination (OSCE) with immediate feedback on surgical clerks' self-confidence and clinical competence.

METHODS

This is a prospective randomized controlled study. Thirty-eight fourth-year medical students starting their surgical clerkship were randomly divided into the control group (n = 19) and the OSCE group (n = 19), where an extra 6-station formative OSCE was given prior to the surgical rotation with immediate feedback on the participant's performance. Self-confidence assessment (SCA) was collected from each participant before, right after the formative OSCE and one month later. Clinical competence was assessed using a mini-clinical evaluation exercise (mini-CEX) with a case of acute abdominal pain and direct observation of procedural skills (DOPS) with incision and suture one month later.

RESULTS

The SCAs were significantly improved in the OSCE group right after the training, and a month later, compared to the control group. The mini-CEX score was significantly higher in the OSCE group compared to the control group, but not the DOPS score of incision and suture.

CONCLUSION

The formative OSCE with immediate feedback could significantly enhance surgical clerks' self-confidence and their clinical competence when taking the history, performing the physical examination, and in clinical reasoning; however, the formative OSCE did not improve their dexterity in performing the procedural skills.

Medical school grades may predict future clinical competence

BACKGROUND

In real-world medical education, there is a lack of reliable predictors of future clinical competencies. Hence, we aim to identify the factors associated with clinical competencies and construct a prediction model to identify "improvement required" trainees.

METHODS

We analyzed data from medical students who graduated from National Yang-Ming University with clerkship training and participated in the postgraduate year (PGY) interview at Taipei Veterans General Hospital. Clinical competencies were evaluated using grades of national objective structured clinical examination (OSCEs). This study used data from medical students who graduated in July 2018 as the derivation cohort (N = 50) and those who graduated in July 2020 (n = 56) for validation.

RESULTS

Medical school grades were associated with the performance of national OSCEs (Pearson r = 0.34, p = 0.017), but the grades of the structured PGY interviews were marginally associated with the national OSCE (Pearson r = 0.268, p = 0.06). A prediction model was constructed to identify "improvement required" trainees, defined: trainees with the lowest 25% of scores in the national OSCEs. According to this model, trainees with the lowest 25% medical school grades predicted a higher risk of the "improvement required" clinical performance (Q1-Q3 vs Q4 = 15% vs 60%, odds ratio = 8.5 [95% confidence interval = 1.8-39.4], p = 0.029). In the validation cohort, our prediction model could accurately classify 76.7% "improvement required" and "nonimprovement required" students.

CONCLUSION

Our study suggests that interventions for students with unsatisfactory medical school grades are warranted to improve their clinical competencies.

The AaLplus near-peer teaching program in Family Medicine strengthens basic medical skills-A five-year retrospective study

Background

Basic medical skills such as history taking and physical examination are essential components of clinical work profiles, but nevertheless have been neglected by conventional preclinical curricula. The near-peer-teaching program AaL^plus [living anatomy plus] teaches basic medical skills, especially history taking, physical examination, and venepuncture, to preclinical students. It is a highly popular compulsory course in the first four semesters (320 students/year, 9h/semester) at Heidelberg University and ends with a formative Objective Structured Clinical Examination (OSCE) during which students receive structured in-depth feedback on their performance. AaL^plus is part of the Department of General Practice’s longitudinal curriculum for Family Medicine.

Objectives

This study aims to assess whether the AaL^plus program has positive effects on students’ clinical skill development and subjective confidence in history taking, physical examination and venepuncture.

Methods

From 2015 to 2019, we asked all AaL^plus participants to rate the program and self-assess their medical skills on 5-point Likert scales (min 1, max 5). In 4-station OSCEs, trained tutors rated the students’ performance in all taught skills using standardized checklists.

Results

From 2015 to 2019 n = 1534 questionnaires returned (response rate = 98.6%, 52.7% females). After course completion, students felt able to take a patient’s history (mean 3.97, SD = 0.75) and perform physical examinations (means range 3.82–4.36, SDs range 0.74–0.89) as well as venepuncture (mean 4.12, SD = 0.88). A large majority of students claimed they acquired these skills in the AaL^plus program. During OSCE, 81.9% passed anamnesis, 93.1% passed physical examination, and 95.4% passed venepuncture (of n = 1556). Students mostly rated the feedback they received during the OSCE as “helpful” or “very helpful” (means for different stations 4.69–4.76, SDs 0.50–0.70).

Conclusions

AaL^plus is a positive example of a peer teaching program in the preclinical stage of medical studies. It successfully trains junior students in essential medical abilities and increases their confidence in their skills. A high percentage of students pass the formative OSCE and evaluate it positively. Consistently high ratings indicate the program’s routine viability. Further studies are needed to analyze if programs like AaL^plus could have an impact on the number of graduates choosing career in Family Medicine.

Value of ultrasound combined with MRI in the diagnosis of primary and recurrent hepatocellular carcinoma

Ultrasound (US) combined with magnetic resonance imaging (MRI) in the diagnosis of primary hepatocellular carcinoma (PHCC) and recurrent hepatocellular carcinoma (RHCC) were compared. The clinical data of 329 patients with hepatocellular carcinoma (HCC) admitted to Qingdao Women and Children's Hospital from June 2015 to December 2017 were collected. One hundred and sixty patients with PHCC were regarded as the PHCC group, and the other 169 patients with RHCC were regarded as the RHCC group. US and MRI were used in the imaging diagnosis of both groups and the results of US combined with MRI, US, and MRI alone were compared. The lesion size in the PHCC group was significantly higher than that in the RHCC group (P<0.05). The MRI fast-in and fast-out rates of the two groups were significantly higher than those of the other three methods (P<0.05). The coincidence rate of MRI in the two groups was higher than that of computed tomography (CT), US, and US combined with MRI (P<0.05). The coincidence rates of CT, US, MRI, and US combined with MRI in PHCC group were significantly higher than those in RHCC group. In PHCC group, MRI was superior to the other methods in the detection of micro HCC (P<0.05). In RHCC group, MRI was significantly better than US in the detection of micro HCC (P<0.05). The sensitivity, specificity, positive predictive value and negative predictive value of MRI were significantly better than the other three methods (P<0.05). MRI alone has the best diagnostic efficacy for micro HCC-type lesions. The diagnostic efficacy of MRI, US, CT, and US combined with MRI in PHCC was better than those in RHCC. In addition to imaging examination, the diagnosis of RHCC should be combined with other indicators for comprehensive diagnosis.