How do Supervising Clinicians of a University Hospital and Associated Teaching Hospitals Rate the Relevance of the Key Competencies within the CanMEDS Roles Framework in Respect to Teaching in Clinical Clerkships?

Does the 'Educational Alliance' conceptualize the student - supervisor relationship when conducting a master thesis in medicine? An interview study

BACKGROUND

Completing a master thesis (MT) is mandatory in many undergraduate curricula in medicine but a specific educational framework to guide the supervisor-student relationship during the MT has not been published. This could be helpful to facilitate the MT process and to more effectively reach the learning objectives related to science education in medicine. An attractive model for this purpose is the 'Educational Alliance' (EA), which focusses on the three components 'clarity and agreement on (a) goals, (b) tasks and (c) relationship & roles'. This study investigated factors that can either facilitate or hinder the process of MTs, and related these to the components of the EA.

METHODS

We conducted semi-structured face-to-face interviews with 20 students and - separately - with their 20 corresponding supervisors, after the MT had been accepted. The interviews included open questions on factors facilitating or hindering the success of the MT. Audio recordings of the interviews were anonymized and transcribed, and then analysed by qualitative content analysis. Also, quantitative data were gathered on satisfaction with the MT process and the supervisory quality (using Likert-type questions).

RESULTS

We were able to analyse all 40 interviews, related to 20 MTs. From the transcripts, we extracted 469 comments related to the research question and categorized these into the four main categories (a) 'Preparation', (b) 'Process', (c) 'Atmosphere', (d) 'Value of the MT'. Interviewees highlighted the importance of a careful preparation phase, clear expectations, a clear research plan, thorough and timely feedback, mutual agreement on timelines, and a positive working atmosphere. Each of these factors could be brought in line with the three components of the EA framework: agreement and clarity of goals, tasks, relationships & roles. Satisfaction with the MT process was rated 8.75 ± 1.22 SD (of 10) points by supervisors, and 7.80 ± 1.61 SD points by students, while supervision quality was rated + 1.51 ± 0.63 SD (scale from - 2 to + 2) by supervisors, and + 1.26 ± 0.93 SD by students.

CONCLUSION

We propose the EA framework as a useful guidance for students, supervisors, and the university towards conducting successful MTs in medicine. Based on the findings, we provide specific recommendations for students, supervisors, and university.

Healthcare Simulation: A Key to the Future of Medical Education - A Review

AIM

Simulation originates from its application in the military and aviation. It is implemented at various levels of healthcare education and certification today. However, its use remains unevenly distributed across the globe due to misconception regarding its cost and complexity and to lack of evidence for its consistency and validity. Implementation may also be hindered by an array of factors unique to the locale and its norms. Resource-poor settings may benefit from diverting external funds for short-term simulation projects towards collaboration with local experts and local material sourcing to reduce the overall cost and achieve long-term benefits. The recent shift of focus towards patient safety and calls for reduction in training duration have burdened educators with providing adequate quantity and quality of clinical exposure to students and residents in a short time. Furthermore, the COVID-19 pandemic has severely hindered clinical education to curb the spread of illness. Simulation may be beneficial in these circumstances and improve learner confidence. We undertook a literature search on MEDLINE using MeSH terms to obtain relevant information on simulation-based medical education and how to best apply it. Integration of simulation into curricula is an essential step of its implementation. With allocations for deliberate practice and mastery learning under supervision of qualified facilitators, this technology is becoming essential in medical education.

PURPOSE

To review the adaptation, spectrum of use, importance, and resource challenges of simulation in medical education and how best to implement it according to learning theories and best practice guides.

CONCLUSION

Simulation offers students and residents with adequate opportunities to practice their clinical skills in a risk-free environment. Unprecedented global catastrophes provide opportunities to explore simulation as a viable training tool. Future research should focus on sustainability of simulation-based medical education in LMICs.

[Residency program under scrutiny (part 2)-How do residents prepare for emergency operations?]

BACKGROUND

Postgraduate medical education in trauma and orthopedic surgery residents largely relates to learning and teaching surgery. During this crucial stage of surgical development some of the didactic challenges are caused by heterogeneous and contradictory expectations of trainees and trainers alike. So how do residents prepare for emergency surgery? To date there is neither an expert consensus nor scientific investigations in the clinical context on this topic.

METHODS

Between February and April 2015 questionnaires were issued to all physicians active in the field of trauma and orthopedic surgery within the Trauma Network East Bavaria (27 clinics, 255 physicians). The participants were asked to rate the importance of certain elements functioning in the preparation of two emergency operations using a Likert scale. The intensity with which residents generally realize these elements of preparation was also documented. The aim was to objectify if and to what extent the presumed normal practices diverge from clinical reality.

RESULTS

A total of 150 questionnaires were analyzed (return rate 59%). Discussion with the consultant (85.3%, n = 128), examination of the patient (80.0%, n = 120), surgical approach (76.0%, n = 114) and study of patient files (68.0%, n = 102) were considered to be the most important elements; however, many of the participants admitted that these elements of preparation are not sufficiently performed.

CONCLUSION

The personal preparation of residents for an emergency operation should be classified as extremely important; however, the requirements and reality do not seem to hold true in the clinical environment. This seems to be most likely due to structural and organizational issues.

Addressing the health advocate role in medical education

The health advocate role is an essential and underappreciated component of the CanMEDs competency framework. It is tied to the concept of social accountability and its application to medical schools for preparing future physicians who will work to ensure an equitable healthcare system. Student involvement in health advocacy throughout medical school can inspire a long-term commitment to address health disparities. The Social Medicine Network (SMN) provides an online platform for medical trainees to seek opportunities to address health disparities, with the goal of bridging the gap between the social determinants of health and clinical medicine. This online platform provides a list of health advocacy related opportunities for addressing issues that impede health equity, whether through research, community engagement, or clinical care.First implemented at the University of British Columbia, the SMN has since expanded to other medical schools across Canada. At the University of Ottawa, the SMN is being used to augment didactic teachings of health advocacy and social accountability. This article reports on the development and application of the SMN as a resource for medical trainees seeking meaningful and actionable opportunities to enact their role as health advocates.

Assessment methods in medical specialist assessments in the DACH region - overview, critical examination and recommendations for further development

Introduction: Specialist medical assessments fulfil the task of ensuring that physicians have the clinical competence to independently represent their field and provide the best possible care to patients, taking into account the current state of knowledge. To date, there are no comprehensive reports on the status of specialist assessments in the German-speaking countries (DACH). For that reason, the assessment methods used in the DACH region are compiled and critically evaluated in this article, and recommendations for further development are described. Methods: The websites of the following institutions were searched for information regarding testing methods used and the organisation of specialist examinations: Homepage of the Swiss Institute for Medical Continuing Education (SIWF), Homepage of the Academy of Physicians (Austria) and Homepage of the German Federal Medical Association (BAEK). Further links were considered and the results were presented in tabular form. The assessment methods used in the specialist assessments are critically examined with regard to established quality criteria and recommendations for the further development of the specialist assessments are derived from these. Results: The following assessment methods are already used in Switzerland and Austria: written examinations with multiple choice and short answer questions, structured oral examinations, the Script Concordance Test (SCT) and the Objective Structured Clinical Examination (OSCE). In some cases, these assessment methods are combined (triangulation). In Germany, on the other hand, the oral examination has so far been conducted in an unstructured manner in the form of a 'collegial content discussion'. In order to test knowledge, practical and communicative competences equally, it is recommended to implement a triangulation of methods and follow the further recommendations described in this article. Conclusion: While there are already accepted approaches for quality-assured and competence-based specialist assessments in Switzerland and Austria at present, there is still a long way to go in Germany. Following the recommendations presented in this article, a contribution could be made to improving the specialist assessments in the DACH region according to the specialist assessments objectives.

How do Lebanese patients perceive the ideal doctor based on the CanMEDS competency framework?

BACKGROUND

During their training, Lebanese medical students develop a high medical expertise but are not focusing on other competencies such as communication, collaboration, erudition, professionalism, leadership and health promotion. There is also insufficient data about patients' preference for these skills. This study describes the different weights patients attribute to these physician's competencies.

METHODS

This is a cross-sectional study based on a questionnaire distributed to 133 Lebanese patients. It included 15 questions assessing how patients prioritize the physician's competencies, with open-ended questions asking them to define "the good doctor". Krippendorff's alpha coefficient was used to analyze the reliability of the competencies' classification.

RESULTS

One hundred twenty five patients completed the questionnaire in this cross-sectional study. Their mean age was 48 ± 16.76 years. When classifying competencies, 73.6% opted for medical expertise as first choice and 48% put communication as second. Based on the Krippendorff's coefficient, we identified a moderate agreement for the seven choices (alpha = 0.44). In open-ended questions, patients defined the good doctor in 325 answers: 64.3% mentioned medical expertise, 34.1% high ethics and 26.2% communication.

CONCLUSIONS

This patient-centered study concurs well with the worldwide practice that puts medical expertise at the center of medical education. However Lebanese patients don't perceive equally other competencies and favor professionalism and communication that should be integrated in priority in students' curricula.

What understanding of economics do medical students have?

Introduction: Economic topics appear in the medical studies curriculum at different times. Despite socio-political relevance, there is hardly any information about the degree of understanding that medical students have of "economics in medicine". The present study addresses the questions: What understanding of "economics in medicine" do medical students have before the start of the Practical Year? To what extent is economic teaching content understood as "economization" from outside the profession? Method: Magdeburg medical students in the 5^th year of study, who participated in preparatory seminars for the Practical Year (PY) in 2014 and 2015 (60 participants each), assessed the relevance of various seminar topics four months prior to the start of the semester. On the basis of a three-stage qualitative-reconstructive partial evaluation, students' economic understanding is explored through secondary analysis: deductive derivation of the analysis units; integrative basic method ("segmentation", "micro-linguistic detailed analysis", "central theme"); development of a theoretical model by placing the central themes in context following Grounded Theory. Results: Based on the theory, 19 free-text answers with economic reference were identified from the total of all free-text answers. Each answer was assigned to at least one of a total of six themes of the students' understanding of economics: de-professionalizing economization, deciding and working economically, ambivalent requirements for efficiency and equity, the doctor as an entrepreneur, economics as relevant learning content, PY as a conflict-laden setting for economized working and learning. The theoretical model contains social, praxeological and professional references, which can themselves be ambivalent and conflicting. Conclusion: Despite their critical attitude, the surveyed medical students are neither hostile to economics nor do they regard economics in medicine as a taboo subject. Economic learning content is recognized as relevant. Educational formats that tackle the tension between patient and system orientation in a problem-oriented manner can be a productive setting for economic reflection.

Promoting medical competencies through a didactic tutor qualification programme - a qualitative study based on the CanMEDS Physician Competency Framework

BACKGROUND

In peer-led tutorial courses, qualified medical students ("tutors") provide their peers with opportunities to deepen their theoretical knowledge effectively and to practice clinical skills already in preclinical semesters. At the Medical Faculty of Heidelberg University, a structured medical didactic qualification programme prepares and trains future tutors for their responsibilities. This programme consists of four modules: 1. medical didactics and group leadership, 2. subject-specific training, 3. performance of tutorial courses as well as 4. collegial advice and reflection on the tutors' activities. The aim of this study is to systematically analyse and present the development of role competencies for medical tutors based on the CanMEDS Physician Competency Framework through the didactic qualification programme.

METHODS

We applied a qualitative research approach to detect CanMEDS role competencies acquisition within the tutor qualification programme. The CanMEDS framework describes key competencies, grouped thematically under seven professional roles. Two tutors and three training coordinators independently assigned the individual modules of the tutor qualification programme to the key competencies of the CanMEDS framework. Tutors and training coordinators compared and discussed the allocations within the groups in a consensus finding process. All authors analysed the findings in order to find out the so-called "hidden curriculum". The views of both groups are presented separately.

RESULTS

The training programme promotes the acquisition of competencies in all seven CanMEDS roles. The roles of the scholar and the leader are promoted in all modules. In addition, the first and fourth module focus predominately on the role of the collaborator, the second on the role of the medical expert and communicator, and the fourth on the role of the professional.

CONCLUSIONS

The systematic analysis through assignment of the CanMEDS roles to the individual modules of the tutor qualification programme documents the comprehensive acquisition of competencies, not only with regard to the tutor activity, but generally with regard to the later role of the physician. The reflection on one's own competency acquisition can support the promotion of corresponding competencies in the qualification programme and their transfer into the professional practice later.

Challenging cases during clinical clerkships beyond the domain of the "medical expert": an analysis of students' case vignettes

Background: During clinical clerkships students experience complex and challenging clinical situations related to problems beyond the domain of the "Medical Expert". Workplace routine may leave little opportunity to reflect on these situations. The University of Zurich introduced a mandatory course directly after the clinical clerkship year (CCY) to work up these situations. Prior to the course each student submitted a vignette on a case he or she had perceived challenging during the CCY and which was not related to the domain of the "Medical Expert" role. In this paper we want to characterize these cases in respect to most prominent themes and related CanMEDS roles. The goal was to inform clinical supervisors about potential teaching demands during the CCY. Methods: All case vignettes submitted by a years' cohort were analysed by three researchers in two ways: for the clinical characteristics and the main theme of the underlying problem and the most prominent CanMEDS roles involved. Themes of the underlying problem were aggregated to overarching topics and subsequently to main categories by pragmatic thematic analysis. Results: 254 case vignettes covered the whole spectrum of clinical disciplines. A wide range of underlying themes could be assigned to five main categories: "communication within team" (23.2%), "communication with patients and relatives" (24.8%), "patient behavior and attitudes" (18.5%), "clinical decision making" (24.0%), and "social and legal issues" (9.4%). Most frequent CanMEDS roles were "Communicator" (26.9%) and "Professional" (23.5%). Conclusions: Cases students perceived as challenging beyond the "Medical Expert" were reported from all clinical disciplines. These were mainly related to communicational and professional issues, mirrored by the CanMEDS roles "Communicator" and "Professional". Therefore, supervisors in clinical clerkships should put an additional teaching focus on communication and professionalism.

Concept and contents of a voluntary course for medical students' achievement of a basic qualification in patient safety during the practical year of medical studies

Objective: Regarding the urgent need of qualification in the field of patient safety, the respective education and training were completed by a voluntary course for 10-15 students in their practical year (PY) provided in cooperation of the private University Hospital of Marburg and the Medical Faculty of the Philipps-University of Marburg. At the same time, this course was intended to develop important knowledge for implementing improvements of the current PY teaching as well as revising the curriculum of Marburg in the medium term. Project description: The PY course on patient safety is offered every six months since 2016 and comprises about 80 lessons. It is based on the principles of shifting simple knowledge transfer to autonomous preparation by the students themselves, of revising already experienced situations of the professional routine, of working with real data of current patients of the PY students, of fostering teamwork, and of applying very deliberately a large combination of methods with numerous interactive types of teaching. The topics of those 13 course units include the majority of the most important problem categories of patient safety as reported in the literature such as communication, drug safety, diagnostic errors, and handovers as well as methods for systematic identification and analysis of errors. In the context of a project task, the students evaluate by means of the global trigger tool and 10 patient files of their current wards each if harm has occurred in the treatment of these patients. Afterwards, the students elaborate in teams of 2 a fishbone diagram for one case where an avoidable harm had emerged. In this graph, the deficient process, the factors contributing to its development, the safety measures that are already applied in the department as well as suggested improvements of the students are visualized. In the final lesson of the course, the students explain and describe their diagram to a member of the managing board of the university hospital. Successful participation is confirmed by an official certificate issued by the Medical Center for Quality in Medicine (Ärztliches Zentrum für Qualität in der Medizin) stating that the course meets the level II requirements ("Basic qualification") of the training concept on "patient safety" of the Germany medical staff. Results: After meanwhile 5 episodes of this course, the whole curriculum obtained a mean score of "very good" based on the standard questionnaire of the Medical Faculty of the University of Marburg. The students perceive an enormous increase in competence regarding the implementation of specific projects to improve patient safety. Furthermore, the intensive cooperation with the PY students led to conceiving and establishing further 7 PY courses for the benefit of patient safety and consolidation of entrustable professional activities. In combination with experiences gained elsewhere from courses on patient safety, the collected knowledge could be used for a first draft of teaching and education of patient safety during the entire clinical studies that takes into account the local conditions. Conclusion: In the process of anchoring the topic of patient safety in the Marburg curriculum of medical studies, the introduction of an extensive voluntary course in the second four months of the clinical internship (practical year) turned out to have a very positive effect. Supported by the management board of the hospital and the medical faculty, we consider it useful to permanently provide such an extensive course for a group of students who want to early and intensively deal with the topic of patient safety.

SaudiMEDs and CanMEDs frameworks: similarities and differences

Background: The SaudiMEDs framework was founded and adopted by the Saudi Deans' Committee in 2011 to ensure that Saudi medical graduates learned core competencies. Meanwhile, CanMEDs was established by the Canadian Royal College of Physicians and Surgeons in 1996 and aimed to establish the abilities and skills of all aspects of medical practice, as well as to ensure the acquisition of basic knowledge related to medical education. The main purpose of this study was to explore the similarities and differences between both frameworks. Methods: In March and April 2017, 15 researchers conducted an extensive review of both the SaudiMEDs and CanMEDs frameworks using a semi-quantitative evaluation with color codes to determine the following: the exact similarities in both frameworks, the close similarities, and the unique differences. Results: According to the coloring system, most of the frameworks were similar. For example, Leadership, Communication and Professionalism were almost identical in both frameworks. There was some degree of similarity between both frameworks in "Collaborator". Furthermore, the SaudiMEDs framework had a unique input which involved the most essential skills that undergraduate medical students must acquire. Conclusion: SaudiMEDs has great potential to improve the quality of Saudi medical graduates in a manner that fits our current and future needs. CanMEDs focuses mainly on outcomes and processes, while SaudiMEDs focuses more on outcomes. SaudiMEDs was not created to provide a copy-and-paste curriculum. The ultimate goal was to create an outcome-based curriculum that ensures the quality of Saudi medical school graduates.

Perceived usability of the National Competence Based Catalogue of Learning Objectives for Undergraduate Medical Education by medical educators at the Hannover Medical School

Background: The aim of this study was to assess usability and identify possible challenges in the implementation of the National Competence Based Catalogue of Learning Objectives for Undergraduate Medical Education (NKLM) among medical educators. Methods: A comprehensive survey among experienced medical educators (responsible for the teaching content and didactical development in their module/field) based on the System Usability Scale (SUS) was carried out focusing on the awareness, usability and challenges of the NKLM. Results: The questionnaire was completed by 52 of the 64 addressed educators. Most of the participants had 6-10 years of teaching experience. 30% of the educators were not familiar with the NKLM. During the evaluation of the NKLM, usability was rather poorly rated. However, 71.9% of medical educators agreed that the various aspects of the medical professions were well integrated in the NKLM with only 12,5% stating that they would not use the NKLM for teaching and lesson preparation. Conclusion: The awareness and promotion of the NKLM need to be improved. Furthermore, these data suggest that - although difficult to use - there is a solid acceptance of the content of the NKLM. Medical educators seem to be willing to use the NKLM. Therefore, further attempts to support colleagues with the handling of the NKLM seem to be inevitable to pave the way for a competency-based curricular change.

[Master trainer concept "structured specialist further education" : A joint project of the German Professional Associations of Internal Medicine, Surgeons and Orthopedic/Trauma Surgeons]

BACKGROUND

The quality requirements in the practice of postgradual medical further education below the normal level of the further education regulations is a barely developed scientific field in Germany. A systematic use of internationally accepted scientific evidence barely exists.

AIM

This research and development project was initiated in 2001 in order to be able to implement a practical but evidence-based model compatible with the existing structure of postgradual medical education. This project has been supported since 2013 by the Professional Associations of Internal Medicine (BDI), Surgeons (BDC) and Orthopedic and Trauma surgeons (BVOU).

METHODS

The development phase of this complex intervention was based on three stages involving stakeholder interviews from relevant groups, the identification of a theoretical model for the construction and systematic literature reviews to identify the relevant evidence.

RESULTS

The basic model for structured specialist further education developed included the creation and implementation of a simple core curriculum for every department, a tool for systematic feedback within the framework of the annual further education interviews and a simple clinical assessment to evaluate the actual clinical performance of physicians in further education. A pilot test of this model was carried out in 150 specialist departments in Germany and continually developed.

DISCUSSION

The project shows that such a program can be systematically developed and pilot studies can be carried out. The central problems in implementation involve the traditional informal further education culture, which as a rule does not implement a systematic elicitation of the state of learning continuously distributed over the whole period of further education and the practical testing of competence development.

Visions and reality: the idea of competence-oriented assessment for German medical students is not yet realised in licensing examinations

Objective: Competence orientation, often based on the CanMEDS model, has become an important goal for modern curricula in medical education. The National Competence Based Catalogue of Learning Objectives for Undergraduate Medical Education (NKLM) has been adopted in Germany. However, it is currently unknown whether the vision of competence orientation has also reached the licensing examination procedures. Methods: Therefore, a prospective, descriptive, single-centre, exemplary study design was applied to evaluate 4051 questions/tasks (from 28 examiners at 7 two-day licensing oral-practical exams) for undergraduate medical students at the University of Ulm. The oral and practical questions/tasks as well as the real bedside assessment were assigned to specific competence roles (NKLM section I), categories (NKLM section II) and taxonomy levels of learning domains. Results: Numerous questions/tasks were set per candidate (day 1/2: 70±24/86±19 questions) in the licensing oral-practical exam. Competence roles beyond the "medical expert" were scarcely considered. Furthermore, practical and communication skills at the bedside were hardly addressed (less than 3/15 min). Strikingly, there was a significant predominance of questions with a low-level taxonomy. Conclusions: The data indicate a misalignment of competence-oriented frameworks and the "real world" licensing practical-oral medical exam, which needs improvement in both evaluation and education processes.

How much GK is in the NKLM? A comparison between the catalogues of exam-relevant topics (GK) and the German National Competence-based Learning Objectives Catalogue for Undergraduate Medical Education (NKLM)

Background: The German National Competence-Based Learning Objectives for Undergraduate Medical Education (NKLM) being adopted in 2015 is designed to contribute to improve the quality of teaching and learning in medicine with respect to competence orientation. For departments, the coherence between teaching, assessment and the content of the catalogues of exam-relevant topics (GK) is a crucial factor. Before making use of the NKLM seriously in curricular development, many faculties demand more transparency regarding the representation in the NKLM of GK topics and in what aspects the NKLM exceeds the GK. Therefore, the aim of the study was to assign the NKLM competencies and objectives to the systematic GK terms, to reveal gaps in their congruence and to determine the percentage of agreement between GK and NKLM. Additionally, the distribution among the NKLM chapters (chap.), of GK content and further competencies relevant for medical practice were analysed. Methods: The textual comparison of GK and NKLM was done by advanced students that were familiar with the NKLM from previous analyses. The comparison was done independently (keyword search, face validity), afterwards consented and matched with independent ratings of GK-2 and chapter 21 done by experts as well as with cross-references to the GK indicated in chapter 12, 13 and 15 of the NKLM. Detailed data is available online: www.merlin-bw.de/gk-nklm-abgleich.html. Results: The degree of correspondence of the GK's six preclinical parts with the NKLM ranges between 94% and 98%, with the clinical GK the degree of correspondence ranging between 84% and 88%. This demonstrates a consistently very high congruence of content. Only 6-16% of the content per GK part could not be assigned to NKLM equivalents. Regarding the distribution of GK content among NKLM chapters, the chapters with classic medical expertise (chapters 12, 13, 16, 17 as well as 20 and 21) show the highest correspondences. Practical medical skills (chapter 14b) can be found in the clinical GK "Health Disorders". Doctor-patient interaction (chapter 14c) and medical scientific skills (chapter 14a) are represented only marginally in the GK. As expected, there were no equivalents to be found in the GK for the new professional roles for medical doctors (chapter 06-11). Discussion: The results presented provide faculties with a useful and detailed data base to evaluate the NKLM more reliably, especially with respect to its relevance for exams. The increased transparency supports the implementation process of the NKLM by reducing content-related uncertainties of departments, invalidating sweeping arguments against the NKLM resulting from uncertainties and thereby minimizing resistance. At the same time a critical review process of the NKLM is encouraged.

How well do final year undergraduate medical students master practical clinical skills?

INTRODUCTION

The clinical examination and other practical clinical skills are fundamental to guide diagnosis and therapy. The teaching of such practical skills has gained significance through legislative changes and adjustments of the curricula of medical schools in Germany. We sought to find out how well final year undergraduate medical students master practical clinical skills.

METHODS

We conducted a formative 4-station objective structured clinical examination (OSCE) focused on practical clinical skills during the final year of undergraduate medical education. Participation was voluntary. Besides the examination of heart, lungs, abdomen, vascular system, lymphatic system as well as the neurological, endocrinological or orthopaedic examination we assessed other basic clinical skills (e.g. interpretation of an ECG, reading a chest X-ray). Participants filled-out a questionnaire prior to the exam, inter alia to give an estimate of their performance.

RESULTS

214 final year students participated in our study and achieved a mean score of 72.8% of the total score obtainable. 9.3% of participants (n=20) scored insufficiently (<60%). We found no influence of sex, prior training in healthcare or place of study on performance. Only one third of the students correctly estimated their performance (35.3%), whereas 30.0% and 18.8% over-estimated their performance by 10% and 20% respectively.

DISCUSSION

Final year undergraduate medical students demonstrate considerable deficits performing practical clinical skills in the context of a formative assessment. Half of the students over-estimate their own performance. We recommend an institutionalised and frequent assessment of practical clinical skills during undergraduate medical education, especially in the final year.