Correlations of clinical assessment tools with written examinations

Comparative study between an intensive small group teaching and a 1-year clinical practice on OSCE

Our school introduced a new curriculum based on faculty-directed, intensive, small-group teaching of clinical skills in the third-year medical students. To examine its effects, we compared the mean scores on an OSCE between the third- and fourth-year medical students. Methods Third- and fourth-year students did rotations at the same five OSCE stations. They then completed a brief self-reporting questionnaire survey to examine the degree of satisfaction with new curriculum in the third-year students and clinical practice in the fourth-year students, as well as their perception of confidence and preparedness. We analyzed the OSCE data obtained from 158 students, 133 of whom also completed the questionnaire. Results Mean OSCE scores on the breast examination and wet smear stations were significantly higher in the third-year group (P < 0.001). But mean OSCE scores of motor-sensory examination and lumbar puncture were significantly higher in the fourth-year group (P < 0.05). The mean OSCE scores had no significant correlation with satisfaction. In addition, the self-ratings of confidence had a high degree of correlation with satisfaction with new curriculum (r = 0.673) and clinical practice (r = 0.692). Furthermore, there was a moderate degree of correlation between satisfaction and preparedness in both groups (r = 0.403 and 0.449). Conclusions There is no significant difference in the effect on the degree of clinical performance and confidence between an intensive-small group teaching and a 1-year clinical practice. If combined, intensive small group teaching and clinical practice would be useful to improve the degree of ability and confidence in medical students.

[Predictors of clinical practice examination scores of fourth year medical students after core clinical clerkships]

PURPOSE

Clinical performance examination (CPX) has been used to assess clinical competence as one step of medical license examination. Initial CPX score of the fourth year medical student is important since it indicates how to prepare successfully for the final examination. This study was conducted to assess the predictors of CPX scores of the fourth year medical students who completed core clinical clerkship.

METHODS

One hundred eleven fourth year medical students took a formative CPX in February. The score was compared with the scores of cognitive area and those of behavioral area which students had acquired in the past. We analyzed the correlation between the scores and determined the predictors of the fourth year CPX score.

RESULTS

The fourth year CPX score showed stronger correlation with the scores of behavioral area than those of cognitive area. The significant predictors of fourth year CPX score included third year simple procedure exam score and third year clerkship CPX score. The risk factors for low fourth year CPX score included second year patient-physician interaction (PPI) score and third year CPX score after adjusted for age, sex, and school type. The risk factors of being selected as a low PPI score group of fourth year included low PPI scores of first, second, and third year exams.

CONCLUSION

Our study highlights importance of educational balance between cognitive and behavioral areas. To improve clinical competence of final year medical students, clinical interview training using standardized patient with other modules is to be enhanced and initiated early in the medical curriculum.

[The relationship between problem-based learning and clinical performance evaluations]

PURPOSE

To explore the relationship between problem-based learning (PBL) evaluations and clinical performance.

METHODS

The study included 117 third-year medical students at Chonnam National University Medical School. The students' first-, second-, and third-year PBL evaluations were compared with their clinical performance examination (CPX) scores in third year. The PBL evaluations were composed of three subscales: tutors' evaluation (students' professional behavior, contribution to group process, and contribution to group content), a report, and a written examination. The CPX assessed four performance categories: history taking, physical examination, information sharing, and patient-physician interaction.

RESULTS

No significant correlation was found between the first-year PBL evaluations and CPX scores; however, the second-year PBL evaluations were significantly correlated with history taking (r=0.186, p=0.044) and patient-physician interaction (r=0.213, p=0.021) of CPX. The third-year PBL evaluations were significantly correlated with physical examination (r=0.248, p=0.007), and patient-physician interaction (r=0.283, p=0.002) of CPX. Several significant correlations between the PBL evaluations subscales and CPX scores were revealed. The PBL tutors' evaluation (r=0.343, p=0.000) and report scores (r=0.210, p=0.023) were significantly correlated with patient-physician interaction of CPX. The contribution to group process of tutors' evaluation was significantly correlated with patient-physician interaction (r=0.186, p=0.045), and the contribution to group content of tutors' evaluation was significantly correlated with physical examination (r=0.187, p=0.044).

CONCLUSION

We found a significant association between PBL evaluations and CPX scores.

Relationship between the Content of the Medical Knowledge Written Examination and Clinical Skill Score in Medical Students

PURPOSE

This study was planned to investigate which medical knowledge examination score-written examination on basic medicine, individual clinical medicine, and comprehensive clinical medicine-was closely related to clinical skill score in medical students.

METHODS

Scores on basic medicine, clinical medicine, graduation assessment, clinical performance examination (CPX), and objective structured clinical examination (OSCE) for 106 students who graduated Dongguk University Medical School from 2010 to 2011 were included, and correlations between them were analyzed using T scores.

RESULTS

All scores of basic medicine, clinical medicine, graduation assessment, CPX, and OSCE correlated significantly with each other. In connection with clinical skill, graduation assessment score showed a strong correlation (r=0.547, p<0.001) with the CPX. Regarding detailed scores on the CPX, history taking score correlated significantly with medical knowledge examination scores (r=0.435~0.406, p<0.001). By regression analysis, the score on graduation assessment was 1 point higher, and that of the CPX increased by 0.538 (p<0.001).

CONCLUSION

Based on our study, comprehensive clinical knowledge is required for medical students to gain the appropriate clinical skills. Therefore, clinical skill practice and lectures that are based on the level of comprehensive clinical knowledge are recommended in the education of clinical skills in medical students.

Relationship between the Clinical Performance Examination and Associated Variables

PURPOSE

The purpose of this study was to identify the causal relationship between the following variables: basic science score, written examination score (Internal medicine and Pediatrics), clinical clerkship score (Internal medicine and Pediatrics), and affective factors (self-efficacy, anxiety, and perception of preparedness).

METHODS

Forty-two medical students took the clinical performance examination (CPX) at the end of the first semester. One day before the CPX, the students completed a brief survey, which included 11 items that sampled their self-efficacy, preparedness and anxiety with regard to the CPX. The responses from the 38 identifiable surveys (90%), out of 42, were analyzed for this study. Structural equation modeling techniques were used to test the relationships between the variables. The students' basic science scores, clinical clerkship scores, and written examination scores were considered for this study.

RESULTS

We found that self-efficacy influenced students' CPX scores indirectly through their preparedness and anxiety. Preparedness influenced students' CPX scores indirectly through their anxiety. Anxiety was predicated on self-efficacy directly or indirectly and it predicted CPX scores. The clinical clerkship scores affected the students' CPX scores indirectly. The written examination scores and basic science scores, however, did not impact the students' CPX scores directly or indirectly. The basic science scores, clinical clerkship scores, and written examination scores were not associated with self-efficacy.

CONCLUSION

Our findings highlight the importance of clinical clerkship education and reasonable medical teaching methods in improving the student self-efficacy for the CPX.