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Han SG, Kim YD, Kong TY, Cho J. Virtual reality-based neurological examination teaching tool(VRNET) versus standardized patient in teaching neurological examinations for the medical students: a randomized, single-blind study. BMC MEDICAL EDUCATION 2021; 21:493. [PMID: 34526004 PMCID: PMC8444400 DOI: 10.1186/s12909-021-02920-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 09/01/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The conventional methods for teaching neurological examination with real patients to medical students have some limitations if the patient with the symptom or disease is not available. Therefore, we developed a Virtual Reality-based Neurological Examination Teaching Tool (VRNET) and evaluated its usefulness in in teaching neurological examinations for the medical students. METHODS In this prospective, randomized, single-blind study, we recruited 98 medical students and divided them into two groups: 1) A standardized patient(SP) group that received the clinical performance examination utilizing standard patients complaining of dizziness was provided neurological findings using conventional method such as verbal description, photographs, and video clips; 2) A SP with VRNET group that was provided the neurological findings using the newly developed tool. Among the 98 students, 3 did not agree to participate, and 95 were enrolled in this study. The SP group comprised 39 students and the SP with VRNET group had 56 students. RESULTS There were no statistical differences in VRNET's realness and student satisfaction between the SP and SP with VRNET groups. However, a statistically significant difference was found in the Neurologic Physical Exam (NPE) score (p = 0.043); the SP with VRNET group had higher NPE scores (3.81 ± 0.92) than the SP group (3.40 ± 1.01). CONCLUSIONS VRNET is useful in teaching senior (graduating) medical students with SP with a neurologic problem.
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Affiliation(s)
- Sang Gil Han
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Tae Young Kong
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Junho Cho
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Hartmann L, Kaden JJ, Strohmer R. Authentic SP-based teaching in spite of COVID-19 - is that possible? GMS JOURNAL FOR MEDICAL EDUCATION 2021; 38:Doc21. [PMID: 33659626 PMCID: PMC7899112 DOI: 10.3205/zma001417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/12/2020] [Accepted: 11/24/2020] [Indexed: 05/04/2023]
Abstract
Objective: Medical conversation plays a central role in disease management and therapy. In teaching, standardized patients (SPs) are increasingly being used to present conversation situations with students and provide feedback afterwards. In order to maintain this teaching concept under pandemic conditions, a digital model was developed that should offer both high security and high authenticity. Methodology: A total of 176 teaching units of 45 minutes each were conducted digitally from May to August 2020. During the teaching units, medical students conducted interviews with SPs portraying various patients. The online conference software "HeiConf" was used for this purpose. During the teaching units, a total of 354 students were able to practice conversation techniques such as NURSE and SPIKES. After the teaching units, feedback was provided by students and SPs. Results: The digital lessons about medical conversation with SPs received positive feedback from SPs and students. The authenticity of the role portrayal of SPs seemed to be unaffected by the new format. Students were successful in training and observing conversation techniques. However, aspects of non-verbal communication, atmosphere and group dynamics as well as further discussions could not be carried out to the same extent as in the usual classroom teaching. Conclusion: The conversion of SP-based teaching to a digital format was successful in a short period of time and was able to prevent a cancellation of teaching units about medical conversation. Concrete conversation techniques could be tried out digitally by students. Due to the deficits of digital teaching in terms of non-verbal communication and atmosphere, a blended-learning format is planned for the future. In the first instance, concrete conversation techniques will be learned online in order to focus more on profound aspects of communication and discussions in a later physical teaching unit with SPs, thus enabling a learning experience that is as authentic as possible.
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Affiliation(s)
- Lilly Hartmann
- Universität Heidelberg - Medizinische Fakultät Mannheim, Mannheim, Germany
| | - Jens J Kaden
- Universität Heidelberg - Medizinische Fakultät Mannheim, Mannheim, Germany
| | - Renate Strohmer
- Universität Heidelberg - Medizinische Fakultät Mannheim, Mannheim, Germany
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Peisachovich E, Da Silva C, May N, Boni M, Zaki-Azat J, Gurevich-Gal R, Hynes L. Understanding Learners' Experiences of Simulated Person Methodology in an Athletic Therapy Program. Cureus 2020; 12:e7194. [PMID: 32269874 PMCID: PMC7137649 DOI: 10.7759/cureus.7194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Key skills required of today's students include critical thinking, problem-solving, creativity, innovation, collaboration, and communication. The acquisition of these skills is foundational to success in a variety of professions and contexts. This study complements a larger simulated person methodology (SPM) project that utilizes simulators (individuals who are trained to realistically reproduce scenarios by providing specific information, displaying signs and behaviours, and creating a realistic encounter in a consistent manner) to replicate real workplace issues, thus affording students an opportunity to apply knowledge and practice real-life skills necessary to the workplace. The primary objective of this study is to apply this innovative teaching approach in higher education as a means of developing proficient critical-thinking and interpersonal skills. Methods This pilot study uses an exploratory mixed-methods design to explore the experiences of 12 students enrolled in an athletic therapy (AT) certificate program that uses SPM. Our hypothesis is that SPM will have a positive impact on student learning and professional development. Results The students responded favourably to the use of SPM. Indeed, 80% "felt challenged and stimulated" and deemed SPM to be a "more effective method" of practicing communication skills than practicing with fellow students. These findings can inform future research and support work towards enhancing this methodology as a pedagogical approach. In tandem, this study and the larger SPM project are poised to provide an effective undergraduate education experience across various faculties at the pilot university. More work is required to align this teaching approach with the AT education program redesign.
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Affiliation(s)
| | - Celina Da Silva
- Medical Education and Simulation, York University, Toronto, CAN
| | - Natasha May
- Teaching Commons, York University, Toronto, CAN
| | | | | | - Raya Gurevich-Gal
- Medical Education and Simulation, Public Health Service, Beer Sheva, ISR
| | - Loriann Hynes
- Kinesiology and Health Sciences, York University, Toronto, CAN
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Braksick SA, Wang Y, Hunt SL, Cathcart-Rake W, Schrage JP, Gronseth GS. Evaluator Agreement in Medical Student Assessment Across a Multi-Campus Medical School During a Standardized Patient Encounter. MEDICAL SCIENCE EDUCATOR 2020; 30:381-386. [PMID: 34457681 PMCID: PMC8368357 DOI: 10.1007/s40670-020-00916-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Class rank and clerkship grades impact a medical student's residency application. The variability and inter-rater reliability in assessment across multiple clinical sites within a single university system is unknown. We aimed to determine if medical student assessment across medical school campuses is consistent when using a standardized scoring rubric. DESIGN/METHODS Attending physicians who participate in assignment of clerkship grades for neurology from three separate clinical campuses of the same medical school observed 10 identical standardized patient encounters completed by third year medical students during the 2017-2018 academic year. Scoring was completed using a standardized rubric. Descriptive analysis and intra-rater comparisons were completed. Evaluations as a part of this study were completed in 2018. RESULTS Of 50 possible points for the patient encounter, the median score among all medical students and all evaluators was 43 (IQR 40, 45.5). Evaluator number 1 provided a statistically significant lower overall score as compared to evaluators 2 and 3 (p = 0.0001 and p = 0.0006, respectively), who were consistently similar in their overall medical student assessment (p = 0.46). Overall agreement between evaluators was good (ICC = 0.805, 95% CI 0.36-0.95) and consistency was excellent (ICC = 0.91, 95% CI 0.75-0.97). CONCLUSIONS Medical student evaluation across multiple clinical campus sites via observation of identical standardized patient encounters and use of a standardized scoring rubric generally demonstrated good inter-rater agreement and consistency, but the small variation seen may affect overall clerkship scores.
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Affiliation(s)
- Sherri A. Braksick
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS USA
- Department of Neurology, Mayo Clinic, Rochester, MN USA
| | - Yunxia Wang
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS USA
| | - Suzanne L. Hunt
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, KS USA
| | | | - Jon P. Schrage
- Department of Internal Medicine, University of Kansas School of Medicine – Wichita Campus, Wichita, KS USA
| | - Gary S. Gronseth
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS USA
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Valentine D, Kurzweil A, Zabar S, Lewis A. Objective Structured Clinical Exams (OSCE) are a feasible method of teaching how to discuss a nonepileptic seizure diagnosis. Epilepsy Behav 2019; 100:106526. [PMID: 31654939 DOI: 10.1016/j.yebeh.2019.106526] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Presenting the diagnosis of psychogenic nonepileptic seizures (PNES) can be a difficult task, but disclosing this information effectively is important to optimize patient outcomes. We sought to develop a standardized method to teach neurology residents how to introduce the diagnosis of PNES via an objective structured clinical examination (OSCE) with a standardized patient (SP). METHODS In conjunction with the New York University School of Medicine Simulation Center (NYSIM), we designed an OSCE in which a resident had to inform a SP of her diagnosis of PNES and discuss a treatment plan. The SP was provided with details to gradually disclose depending on what the resident said about the history of her episodes, triggers for her episodes and her history of sexual abuse. Each encounter was observed by an attending physician who provided real-time feedback to the resident after the session. Additionally, the SP completed an objective written checklist of items the resident should have covered in the session and gave them verbal feedback. RESULTS Twenty-six adult neurology (n = 22), child neurology (n = 3), and neuropsychiatry (n = 1) residents participated in this OSCE in 2018 and 2019, with full data available for 25 participants. Residents reported the OSCE was very useful (mean Likert score of 4.9/5). They felt moderately prepared (mean Likert score 3.8/5) and rated their performance as a mean of 3.3/5. On the SP's checklist, most residents were rated as Well Done in the domains of information gathering, relationship development, and education and counseling. Only in the domain of psychosocial assessment were most residents rated as Not Done (only 7/25 inquired about past trauma as a risk factor for PNES). SIGNIFICANCE The OSCEs are a feasible and useful way to teach neurology residents about discussing PNES, as they allow for provision of real-time practice and feedback in a safe environment without real patients.
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Affiliation(s)
- David Valentine
- Department of Neurology, New York University School of Medicine, New York, NY, United States of America.
| | - Arielle Kurzweil
- Department of Neurology, New York University School of Medicine, New York, NY, United States of America
| | - Sondra Zabar
- Department of Medicine, New York University School of Medicine, New York, NY, United States of America
| | - Ariane Lewis
- Department of Neurology, New York University School of Medicine, New York, NY, United States of America; Department of Neurosurgery, New York University School of Medicine, New York, NY, United States of America
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Williams B, Song JJY. Are simulated patients effective in facilitating development of clinical competence for healthcare students? A scoping review. Adv Simul (Lond) 2016; 1:6. [PMID: 29449975 PMCID: PMC5796606 DOI: 10.1186/s41077-016-0006-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 01/24/2016] [Indexed: 11/13/2022] Open
Abstract
Background The need to evaluate the effectiveness of SPs in improving clinical competence has attracted a heightened interest across the healthcare professions, with some prevailing gaps in their evidence. Using a scoping review approach, this study aims to provide an overview on the effectiveness of SPs in facilitating the development of clinical competence for healthcare students. Methods This scoping review applied the first five out of the six-stage methodological framework developed by Levac et al. (Implementation Science 5:69), as follows: 1) Identify the research question; 2) identify relevant studies; 3) study selection; 4) charting the data; and 5) collating, summarising and reporting the results. The search was performed on four databases, including Medline, EMBASE, CINAHL and Scopus. Results A total of 33 articles were included in this study (out of 968 identified), comprising of 20 cross-sectional studies, eight randomised controlled trials and five longitudinal studies. The studies were examined and categorised for further discussion in the three domains of clinical competence; technical, non-technical and cognitive skills. Overall, 24 out of 33 studies showed effectiveness of SPs in facilitating students’ clinical competence. Conclusion This scoping review serves to provide guidance for future healthcare education development, by illustrating the effectiveness of SPs in improving students’ clinical competence as evidenced in the literature. In doing so, it highlights the potential of SPs in facilitating students’ acquisition of the necessary skills for clinical practice.
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Affiliation(s)
- Brett Williams
- Department of Community Emergency Health & Paramedic Practice, Monash University, Peninsula Campus, McMahons Road, PO Box 527, 3199 Frankston, VIC Australia
| | - Jane Jee Yeon Song
- Department of Community Emergency Health & Paramedic Practice, Monash University, Peninsula Campus, McMahons Road, PO Box 527, 3199 Frankston, VIC Australia
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Abushouk AI, Duc NM. Curing neurophobia in medical schools: evidence-based strategies. MEDICAL EDUCATION ONLINE 2016; 21:32476. [PMID: 27680578 PMCID: PMC5040837 DOI: 10.3402/meo.v21.32476] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 08/29/2016] [Accepted: 08/30/2016] [Indexed: 05/14/2023]
Abstract
Medical students often perceive neurology as the most difficult medical specialty. This perception is described as 'neurophobia' in the medical literature. Several studies have cited poor teaching, complex examination, and separation of basic and clinical sciences as major factors in the development of neurophobia. These negative perceptions can have serious implications, such as decreasing the students' desire to consider neurology as a future career and increasing referrals from other specialists to avoid dealing with neurological conditions. Faced with increasing demands of healthcare systems and the global burden of neurological conditions, there is a rising need for further research and innovative strategies to improve students' perceptions of clinical neurology. This review discusses evidence-based recommendations and educational interventions to cure neurophobia in medical education.
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Affiliation(s)
| | - Nguyen Minh Duc
- Faculty of Public Health, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam;
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Davies ML, Schonder KS, Meyer SM, Hall DL. Changes in Student Performance and Confidence with a Standardized Patient and Standardized Colleague Interprofessional Activity. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2015; 79:69. [PMID: 26396278 PMCID: PMC4571047 DOI: 10.5688/ajpe79569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 10/23/2014] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To assess the impact of a standardized patient and standardized colleague interprofessional activity on student performance and perceived confidence in communicating with patients and physicians. METHODS Students in the third professional year were presented with a practice and final activity including a standardized patient interaction, SOAP note preparation, and standardized colleague interaction. Student performance was measured by assessment rubrics on practice and final activities. Students' perceived confidence was measured via presurvey and postsurvey. RESULTS Students performed significantly better from the practice to the final activity with regard to communicating with patients, SOAP note, and the overall activity with a mean difference (95% CI) of 9.2 (6.9-11.5), 3.6 (1.3-5.8), and 3.9 (2.0-5.7), respectively. There was a positive significant change from presurvey to postsurvey in students' confidence talking to patients and physicians on majority of questions. CONCLUSION This study demonstrates that active learning and integrated assessments improve overall student performance. Integration of interprofessional education also has positive effects on students' perceived confidence.
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Affiliation(s)
- Marie L Davies
- University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania ; University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania ; Western University of Health Sciences College of Pharmacy, Pomona, California
| | - Kristine S Schonder
- University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania ; University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Susan M Meyer
- University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Deanne L Hall
- University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania ; University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Larsen DP, Butler AC, Lawson AL, Roediger HL. The importance of seeing the patient: test-enhanced learning with standardized patients and written tests improves clinical application of knowledge. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2013; 18:409-425. [PMID: 22618856 DOI: 10.1007/s10459-012-9379-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 05/11/2012] [Indexed: 06/01/2023]
Abstract
Previous research has shown that repeated retrieval with written tests produces superior long-term retention compared to repeated study. However, the degree to which this increased retention transfers to clinical application has not been investigated. In addition, increased retention obtained through written testing has not been compared to other forms of testing, such as simulation testing with a standardized patient (SP). In our study, 41 medical students learned three clinical topics through three different learning activities: testing with SPs, testing using written tests, and studying a review sheet. Students were randomized in a counter-balanced fashion to engage in one learning activity per topic. They participated in four weekly testing/studying sessions to learn the material, engaging in the same activity for a given topic in each session. Six months after initial learning, they returned to take an SP test on each topic, followed by a written test on each topic 1 week later. On both forms of final testing, we found that learning through SP testing and written testing generally produced superior long-term retention compared to studying a review sheet. SP testing led to significantly better performance on the final SP test relative to written testing, but there was no significant difference between the two testing conditions on the final written test. Overall, our study shows that repeated retrieval practice with both SPs and written testing enhances long-term retention and transfer of knowledge to a simulated clinical application.
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Affiliation(s)
- Douglas P Larsen
- Department of Neurology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8111, St. Louis, MO 63110, USA.
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McColgan P, McKeown PP, Selai C, Doherty-Allan R, McCarron MO. Educational interventions in neurology: a comprehensive systematic review. Eur J Neurol 2013; 20:1006-16. [DOI: 10.1111/ene.12144] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 02/14/2013] [Indexed: 11/30/2022]
Affiliation(s)
- P. McColgan
- Department of Neurodegenerative Disease; UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square; London UK
| | - P. P. McKeown
- School of Medicine, Dentistry and Biomedical Sciences; Queen's University of Belfast Centre for Medical Education; Belfast UK
| | - C. Selai
- Institute of Neurology, Queen Square; London UK
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Lukas RV, Adesoye T, Smith S, Blood A, Brorson JR. Student assessment by objective structured examination in a neurology clerkship. Neurology 2012; 79:681-5. [PMID: 22855865 DOI: 10.1212/wnl.0b013e3182648ba1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES We evaluated the reliability and predictive ability of an objective structured clinical examination (OSCE) in the assessment of medical students at the completion of a neurology clerkship. METHODS We analyzed data from 195 third-year medical students who took the OSCE. For each student, the OSCE consisted of 2 standardized patient encounters. The scores obtained from each encounter were compared. Faculty clinical evaluations of each student for 2 clinical inpatient rotations were also compared. Hierarchical regression analysis was applied to test the ability of the averaged OSCE scores to predict standardized written examination scores and composite clinical scores. RESULTS Students' OSCE scores from the 2 standardized patient encounters were significantly correlated with each other (r = 0.347, p < 0.001), and the scores for all students were normally distributed. In contrast, students' faculty clinical evaluation scores from 2 different clinical inpatient rotations were uncorrelated, and scores were skewed toward the highest ratings. After accounting for clerkship order, better OSCE scores were predictive of better National Board of Medical Examiners standardized examination scores (R(2)Δ = 0.131, p < 0.001) and of better faculty clinical scores (R(2)Δ = 0.078, p < 0.001). CONCLUSIONS Student assessment by an OSCE provides a reliable and predictive objective assessment of clinical performance in a neurology clerkship.
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Affiliation(s)
- Rimas V Lukas
- Department of Neurology, University of Chicago, IL, USA.
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