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Angarita FA, Price B, Castelo M, Tawil M, Ayala JC, Torregrossa L. Improving the competency of medical students in clinical breast examination through a standardized simulation and multimedia-based curriculum. Breast Cancer Res Treat 2018; 173:439-445. [PMID: 30315436 DOI: 10.1007/s10549-018-4993-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 10/03/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Clinical breast examination (CBE) is an important step in the assessment of patients with breast-related complaints. We developed a standardized simulation and multimedia-based (SSMBI) curriculum using current evidenced-based recommendations. This study aimed to determine if SSMBI training resulted in better performance (examination scores and detection of abnormal findings) than the traditional teaching method. METHODS Novice fourth-year medical students were exposed to the SSMBI curriculum (n = 68) or traditional (n = 52) training. The traditional group was taught by a lecture and attending weekly clinics where they had hands-on experience. The SSMBI group underwent a structured lecture followed by an instructional video and dedicated simulated teaching. Both groups were assessed through a written knowledge exam and an objective structured clinical examination (OSCE). Student's t test and χ2 tests were used to assess differences in CBE technique and knoweldge. RESULTS Students who underwent SSMBI training had significantly higher numbers of correct answers describing the different steps and justifications of CBE. OSCE performance was significantly higher in the SSMBI group. SSMBI-trained students were more likely to complete all the necessary CBE steps compared to traditionally-trained students (88.2% vs. 28.2%, p < 0.00001). The SSMBI group was also more systematic and more likely to perform adequate inspection, palpation, examination of the nipple-areolar complex, and identify and characterize a palpable lesion (p < 0.05). CONCLUSIONS Formal SSMBI training is an important asset when teaching medical students how to perform a CBE. Real clinical experience is still necessary to refine this skill and the physician-patient interaction.
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Affiliation(s)
- Fernando A Angarita
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Benjamin Price
- Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Matthew Castelo
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Mauricio Tawil
- Department of Surgery, Pontificia Universidad Javeriana, Bogota, Colombia.,Department of Surgery, Hospital Universitario San Ignacio, Carrera 7 Nº 40 - 62, Oficina 718, Bogotá, Colombia
| | - Juan Carlos Ayala
- Department of Surgery, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Lilian Torregrossa
- Department of Surgery, Pontificia Universidad Javeriana, Bogota, Colombia. .,Department of Surgery, Hospital Universitario San Ignacio, Carrera 7 Nº 40 - 62, Oficina 718, Bogotá, Colombia.
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2
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van Vught AJAH, van den Brink GTWJ, Hilkens MGEC, van Oers JAH. Analysis of the level of clinical skills of physician assistants tested with simulated intensive care patients. J Eval Clin Pract 2018; 24:580-584. [PMID: 29878608 PMCID: PMC6001577 DOI: 10.1111/jep.12937] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Since adequate staffing in intensive care units (ICUs) is an increasing problem worldwide, we investigated whether physician assistants (PAs) are able to substitute medical residents (MR) in ICUs with at least the same quality of clinical skills. In this study, we analysed the level of clinical skills of PAs in direct comparison with those who traditionally performed these tasks, ie, MR with 6 to 24 months of work experience in the ICU. METHOD Physician assistants and MRs in the ICUs were observed on their clinical skills by means of a simulated ICU comprising 2 scenarios on a human patient simulator with typical ICU cases. The level of clinical skills of PAs and MRs was videotaped and scored with predefined checklists by 2 independent intensivists per scenario. Percentage of the total score was calculated, and means were compared by Student t test. RESULTS A total of 11 PAs and 10 MRs participated in the study. Physician assistants and MRs scored equal (PA 66% ± 13% vs MR 68% ± 9%, P = .86) on their clinical performance in the simulated ICU setting. CONCLUSION This study showed equal performance of PAs and MRs on clinical skills in the simulated ICU setting.
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Affiliation(s)
- Anneke J A H van Vught
- Faculty of Health, Behavior and Society, HAN University of Applied Sciences, Postbus 6960, Nijmegen, HG, 6503, Netherlands
| | - Geert T W J van den Brink
- Faculty of Health, Behavior and Society, HAN University of Applied Sciences, Postbus 6960, Nijmegen, HG, 6503, Netherlands
| | - Murielle G E C Hilkens
- Department of Intensive Care, Radboud University Medical Center, Postbus 9101, Nijmegen, HB, 6500, Netherlands
| | - Jos A H van Oers
- Department of Intensive care, Elisabeth-TweeSteden Ziekenhuis, Postbus 90151, 5000, LC Tilburg, Netherlands
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3
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Cevik AA, Noureldin A, El Zubeir M, Abu-Zidan FM. Assessment of EFAST training for final year medical students in emergency medicine clerkship. Turk J Emerg Med 2018; 18:100-104. [PMID: 30191188 PMCID: PMC6107923 DOI: 10.1016/j.tjem.2018.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/21/2018] [Accepted: 05/21/2018] [Indexed: 10/25/2022] Open
Abstract
Background Extended Focused Assessment Sonography for Trauma (EFAST) is an important bedside tool for the management of multiple trauma patients. We aimed to evaluate the assessment of our EFAST education in the Emergency Medicine Clerkship (EMC) for final year medical students and the correlations of EFAST marks with other practical skill stations and the final multiple choice question (MCQ) exam marks. Methods Fifty-four final year medical students were trained on performing EFAST on human models during their 4-week clerkship. Students received an hour of didactic lecture, 4-hours practical sessions on human models, and completed a minimum of three EFAST examinations on trauma patients. Finally, the EFAST performance was evaluated on human models using a standard evaluation form during an Objective Structured Clinical Examination (OSCE). The marks of 51 students who completed the final exam were analyzed. Results The overall passing rate of the EFAST station was 88% (n: 45). EFAST station mark had significant weak correlations with other OSCE stations marks (p = 0.027, rho = 0.31), and with the final EMC mark (p = 0.032, rho = 0.3), but not with the final MCQ exam. Conclusions Final year medical students demonstrated effective EFAST learning as measured by their examination performance. One hour EFAST training and 4 -hours practice provide an acceptable level of skill for medical students. The EFAST final marks showed significant weak correlation with other OSCE station marks and final clerkship marks, but not with the final MCQ exam mark which assesses a different cognitive learning domain.
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Affiliation(s)
- Arif Alper Cevik
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,Department of Emergency Medicine, Tawam Hospital, Al Ain, United Arab Emirates
| | - Abdel Noureldin
- Department of Emergency Medicine, Tawam Hospital, Al Ain, United Arab Emirates
| | - Margret El Zubeir
- Department of Medical Education, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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4
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Alamiri NN, Maliska CM, Chancellor-McIntosh H, Sclabas G. Comparing Surgical Clerkship Performance of Medical and Physician Assistant Students. JOURNAL OF SURGICAL EDUCATION 2017; 74:466-470. [PMID: 28209501 DOI: 10.1016/j.jsurg.2016.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/09/2016] [Accepted: 11/16/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Third-year medical students (MS-III) and second-year physician assistant students (PA-S) have similar core clinical rotations during their education. Uniquely at our institution, both groups rotate together and are assessed by the same evaluation and grading standards. This study compares the performance of MS-III and PA-S during their combined surgical clerkship rotation. DESIGN A retrospective analysis on students' final clerkship grades, individual grades for clinical performance evaluation, objective structured clinical examination, faculty tutorials, and National Board of Medical Education (NBME) general surgery examination for academic years 2013 and 2014. Statistical analysis using the Statistical Package for Social Sciences (SPSS) was used. A p < 0.05 was considered statistically significant. SETTING The study took place in the Department of Surgery at the University of Oklahoma School of Community Medicine, Tulsa, Oklahoma. PARTICIPANTS All MS-III and PA-S that performed a clinical rotation in the Department of Surgery at the University of Oklahoma School of Community Medicine, Tulsa were included in the study. Fourth-year medical students on elective rotations were excluded. A total of 95 students were included, 51 MS-III and 44 PA-S. RESULTS The results indicated that MS-III had statistically significant higher clinical performance evaluation (p = 0.005), NBME (p < 0.001), and tutorial scores (p = 0.03) as compared to PA-S. However, there were no statistically significant findings between final grades and objective structured clinical examination scores. In comparing 2013 to 2014 MS-III classes, no statistically significant differences existed, but the 2014 PA-S class had statistically significant higher NBME (p = 0.022) and tutorial scores (p = 0.015) as compared to 2013 PA-S class. CONCLUSION MS-III performed better in tests evaluating medical knowledge, possibly a reflection of more in-depth different organ systems physiology and pathophysiology education that MS-III receive. No significant difference in clerkship performance was found. This could be attributed to similar clinical education both receiving as well as PA-S often having a history of prior professional health care experience. Over time of the study, PA-S performance seems to have improved. These observations might help to improve future curricula for MS-III as well as for PA-S.
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Affiliation(s)
- Nasser N Alamiri
- Department of Surgery, University of Oklahoma College of Medicine, Tulsa, Oklahoma.
| | | | - Heather Chancellor-McIntosh
- Office for Research Development and Scholarly Activity, University of Oklahoma College of Medicine, Tulsa, Oklahoma
| | - Guido Sclabas
- Department of Surgery, University of Oklahoma College of Medicine, Tulsa, Oklahoma
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van Vught AJAH, Hettinga AM, Denessen EJPG, Gerhardus MJT, Bouwmans GAM, van den Brink GTWJ, Postma CT. Analysis of the level of general clinical skills of physician assistant students using an objective structured clinical examination. J Eval Clin Pract 2015; 21:971-5. [PMID: 26376735 DOI: 10.1111/jep.12418] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2015] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Anneke J A H van Vught
- Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Agatha M Hettinga
- Institute for (Bio) Medical Education, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eddie J P G Denessen
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Martin J T Gerhardus
- Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Geert A M Bouwmans
- Institute for (Bio) Medical Education, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Cornelis T Postma
- Institute for (Bio) Medical Education, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Designing and Implementing the Objective Structured Clinical Examination in Anesthesiology. Anesthesiology 2014; 120:196-203. [DOI: 10.1097/aln.0000000000000068] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Abstract
Since its description in 1974, the Objective Structured Clinical Examination (OSCE) has gained popularity as an objective assessment tool of medical students, residents, and trainees. With the development of the anesthesiology residents’ milestones and the preparation for the Next Accreditation System, there is an increased interest in OSCE as an evaluation tool of the six core competencies and the corresponding milestones proposed by the Accreditation Council for Graduate Medical Education.
In this article the authors review the history of OSCE and its current application in medical education and in different medical and surgical specialties. They also review the use of OSCE by anesthesiology programs and certification boards in the United States and internationally. In addition, they discuss the psychometrics of test design and implementation with emphasis on reliability and validity measures as they relate to OSCE.
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Abstract
We examined the effectiveness of teaching ankle–brachial index (ABI) measurement to medical students. ABI was estimated in 28 lower limbs by an experienced vascular surgeon. After a 2-week training course, 5 fourth-year students repeated the estimations and their results were compared with that of the trainer’s. There was no difference in ABI values between trainees and trainer for subjects with mild-to-moderate peripheral arterial disease (PAD; 0.77 ± 0.22 vs 0.77 ± 0.19, respectively, P = .95). In the 4 normal limbs, ABI was 1.37 ± 0.12 and 1.16 ± 0.11, as measured by the trainer and the trainees, respectively ( P < .00001). In subjects with severe PAD, trainees tended to overestimate ABI ( P = .0002) in the beginning of the educational process, but this was no longer the case at a later stage of the training with no difference in ABI values between the 2 examiner groups ( P = .09). In conclusion, training of medical students in ABI measurement can be helpful toward accurate estimation of PAD and merits further practice.
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8
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The Reliability of a Musculoskeletal Objective Structured Clinical Examination in a Professional Physical Therapist Program. ACTA ACUST UNITED AC 2013. [DOI: 10.1097/00001416-201301000-00011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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9
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Isenberg GA, Berg KW, Veloski JA, Berg DD, Veloski JJ, Yeo CJ. Evaluation of the use of patient-focused simulation for student assessment in a surgery clerkship. Am J Surg 2011; 201:835-40. [DOI: 10.1016/j.amjsurg.2010.01.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 01/21/2010] [Accepted: 01/21/2010] [Indexed: 10/19/2022]
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Delzell JE, Chumley H, Webb R, Chakrabarti S, Relan A. Information-gathering patterns associated with higher rates of diagnostic error. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2009; 14:697-711. [PMID: 19219606 DOI: 10.1007/s10459-009-9152-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Accepted: 01/06/2009] [Indexed: 05/27/2023]
Abstract
Diagnostic errors are an important source of medical errors. Problematic information-gathering is a common cause of diagnostic errors among physicians and medical students. The objectives of this study were to (1) determine if medical students' information-gathering patterns formed clusters of similar strategies, and if so (2) to calculate the percentage of incorrect diagnoses in each cluster. A total of 141 2nd year medical students completed a computer case simulation. Each student's information-gathering pattern included the sequence of history, physical examination, and ancillary testing items chosen from a predefined list. We analyzed the patterns using an artificial neural network and compared percentages of incorrect diagnoses among clusters of information-gathering patterns. We input patterns into a 35 x 35 self organizing map. The network trained for 10,000 epochs. The number of students at each neuron formed a surface that was statistically smoothed into clusters. Each student was assigned to one cluster, the cluster that contributed the largest value to the smoothed function at the student's location in the grid. Seven clusters were identified. Percentage of incorrect diagnoses differed significantly among clusters (Range 0-42%, Chi (2) = 13.62, P = .034). Distance of each cluster from the worst performing cluster was used to rank clusters. This rank was compared to rank determined by percentage incorrect. We found a high positive correlation (Spearman Correlation = .893, P = .007). Clusters closest to the worst performing cluster had the highest percentages of incorrect diagnoses. Patterns of information-gathering were distinct and had different rates of diagnostic error.
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Affiliation(s)
- John E Delzell
- University of Kansas School of Medicine, 3901 Rainbow Blvd, Mailstop 4010, Kansas City, KS 66160, USA.
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11
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Rushforth HE. Objective structured clinical examination (OSCE): review of literature and implications for nursing education. NURSE EDUCATION TODAY 2007; 27:481-90. [PMID: 17070622 DOI: 10.1016/j.nedt.2006.08.009] [Citation(s) in RCA: 169] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2005] [Revised: 08/03/2006] [Accepted: 08/29/2006] [Indexed: 05/12/2023]
Abstract
Objective structured clinical examination (OSCE) has been used to assess medical students since the mid 1970s, and in more recent years has been increasingly utilised to assess students from nursing and the allied health professions. This growing utilisation has led to considerable debate within the literature pertaining to the optimal use of OSCE as an assessment process. The purpose of this paper is to present a narrative review regarding some of the key issues affecting the utilisation of OSCE within the assessment of nursing students. The paper briefly reviews the historical development of OSCE within health professional assessment, and summarises some of its key strengths and limitations. It then offers a more 'in depth' consideration of the research literature pertaining to the reliability and validity of the OSCE process, which is then used as a basis for exploring some of the particular issues that need to be considered when OSCE is used to assess nursing students. Key issues identified include the need to carefully prepare and pilot new OSCE examinations and marking tools in order to ensure reliability and validity is optimised, and also the need to carefully consider the length, number and interdependence of OSCE stations to ensure that the potentially competing requirements of validity and reliability are balanced. The paper also recognises that whilst the evidence base regarding OSCE is extensive, the evidence base specific to nursing is more limited. There is therefore scope for further research in this area, as well as the need for careful debate regarding how national guidance may be a way of enhancing and standardising future OSCE examinations. The paper concludes that whilst caution must be applied in relying on OSCE as a sole means of practitioner assessment, used carefully it can make a helpful and meaningful contribution to health professional education.
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Affiliation(s)
- Helen E Rushforth
- School of Nursing and Midwifery, Building 67, University Road, Highfield, Southampton SO17 1BJ, United Kingdom.
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Willett LL, Estrada CA, Castiglioni A, Massie FS, Heudebert GR, Jennings MS, Centor RM. Does Residency Training Improve Performance of Physical Examination Skills? Am J Med Sci 2007; 333:74-7. [PMID: 17301584 DOI: 10.1097/00000441-200702000-00002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Few studies use objective structured clinical examinations (OSCEs) to measure physical examination skills of internal medicine residents. Little is known about performance by year of residency training. PURPOSE To determine differences between postgraduate year (PGY)-1 and PGY-3 residents on performance and comfort of physical examination skills. METHODS In a cross-sectional study, we tested 16 PGY-1 (weeks 0 and 4) and 8 PGY-3 internal medicine residents with a five-station OSCE. RESULTS PGY-3 residents performed better than PGY-1 week 0 residents (P = 0.03) but not PGY-1 week 4 residents (P = 0.42). PGY-1 resident performance improved after 1 month of inpatient wards experience (P < 0.001). PGY-3 residents had higher comfort compared to PGY-1 week 0 residents (P = 0.003) but not PGY-1 week 4 residents (P = 0.10). CONCLUSIONS Senior residents performed better and were more confident on physical examination skills, but the difference disappeared after 1 month of internship. This calls into question how much further learning occurs with physical examination throughout residency training.
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Affiliation(s)
- Lisa L Willett
- Division of General Internal Medicine, Department of Medicine, University of Alabama at Birmingham, Huntsville Regional Medical Campus, Birmingham, Alabama 35294-0012, USA.
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Xydas S. A multifaceted approach to the evaluation of surgical residents: a resident's view. CURRENT SURGERY 2005; 62:354-5. [PMID: 15890226 DOI: 10.1016/j.cursur.2004.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Steve Xydas
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
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14
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Carter MB, Wesley G, Larson GM. Didactic lecture versus instructional standardized patient interaction in the surgical clerkship. Am J Surg 2005; 189:243-8. [PMID: 15721000 DOI: 10.1016/j.amjsurg.2004.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2004] [Revised: 09/17/2004] [Accepted: 09/17/2004] [Indexed: 11/26/2022]
Abstract
BACKGROUND Medical schools increasingly employ the standardized patient interaction (SPI) as a teaching and testing modality to prepare students for USMLE Step 2 Clinical Skills (Step 2 CS). However, little is known about the perceptions medical students have toward SPIs. We hypothesized that the SPI would increase the self-confidence of surgery students in their history and physical examination (H&P) skills as compared with the classic lecture format and that students would perceive the SPI as a valuable learning tool. METHODS Students (n = 126) on the junior surgery clerkship were randomized into two groups. Group A (n = 61) received a didactic lecture on acute appendicitis. Group B (n = 65) participated in an SPI in which the portrayed patient had acute appendicitis. Student perceptions were surveyed by written questionnaire pre- and postencounter using a 5-point Likert scale, with 5 being the most favorable rating. Data (perceptions, performances on the SPI, clerkship grades) were compared using a Student t test followed by the Mann-Whitney rank sums test. RESULTS Group A "enjoyed" the lecture format more than group B "enjoyed" the SPI format (3.4 +/- 0.1 versus 2.6 +/- 0.1, P <.001) and perceived the lecture as having more value to their overall education (3.5 +/- 0.1 versus 2.6 +/- 0.1, P <.001) than the SPI group. Surprisingly, student self-confidence in their H&P skills increased after the didactic lecture (from 3.6 +/- 0.1 to 4.1 +/- 0.1, P = .001) but not after the SPI (from 3.6 +/- 0.1 to 3.8 +/- 0.1, P = not significant). CONCLUSIONS The didactic lecture format was not only enjoyed and valued more than the SPI, but our surgery students also perceived it as superior to the SPI in building confidence in history and physical examination skills. These findings suggest that surgical educators should develop ways to improve students' perceptions and attitudes surrounding the surgical SPI.
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Affiliation(s)
- Mary B Carter
- Office of Medical Education, School of Medicine, University of Louisville, Louisville, KY 40292, USA.
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15
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Nagoshi M, Williams S, Kasuya R, Sakai D, Masaki K, Blanchette PL. Using standardized patients to assess the geriatrics medicine skills of medical students, internal medicine residents, and geriatrics medicine fellows. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2004; 79:698-702. [PMID: 15234924 DOI: 10.1097/00001888-200407000-00018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE Medical schools and residency programs are placing additional emphasis on including clinical geriatrics competencies within their curricula. An eight-station, Geriatric Medicine Standardized Patient Examination (GSPX) was studied as a method to assess bedside geriatrics clinical skills over the continuum of medical education from medical school through residency and fellowship training. METHOD The GSPX was administered to 39 medical students, 49 internal medicine residents, and 11 geriatrics medicine fellows in 2001-02. Reliability of standardized patient (SP) checklists and rating scales used to assess examinees' performance was measured by Cronbach's alpha. Validity was measured by surveying the examinees' assessment of fairness, individual case length, difficulty, and believability, and by faculty standard setting for each level of trainee. RESULTS Reliability was high (alpha =.89). All levels of examinees found the SPs to be believable, station lengths to be adequate, and rated the GSPX as a fair assessment. Students rated the cases as more difficult. Previous experience with similar real patients increased significantly with level of training (Pearson's r =.48, p <.0001). Faculty set passing scores that increased from students to residents to fellows. However, GSPX scores decreased with level of training (r = -.25, p =.01). CONCLUSION The GSPX is a reliable measure of geriatrics medicine skills with adequate face validity for examinees at all levels. However, GSPX scores did not increase with level of training, suggesting that a single form of the examination cannot be used across the continuum of training. Potential modifications to the GSPX that might provide more discrimination between levels of training are currently being explored.
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Affiliation(s)
- Michael Nagoshi
- Center for Clinical Skills, Department of Medicine, Univesity of Hawaii John A. Burns School of Medicine, Honolulu 96817, USA
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Affiliation(s)
- R S Sidhu
- Department of Surgery, University of Toronto and the University of Toronto Faculty of Medicine Centre for Research in Education at the University Health Network, Toronto, Ontario, Canada
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Lindsay KW. Periodic progress evaluation. ACTA NEUROCHIRURGICA. SUPPLEMENT 2004; 90:77-95. [PMID: 15553121 DOI: 10.1007/978-3-7091-0633-4_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- K W Lindsay
- Department of Neurosurgery, Southern General Hospital, Glasgow, UK.
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