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Lebdai S, Bouvard B, Martin L, Annweiler C, Lerolle N, Rineau E. Objective structured clinical examination versus traditional written examinations: a prospective observational study. BMC MEDICAL EDUCATION 2023; 23:69. [PMID: 36707797 PMCID: PMC9883896 DOI: 10.1186/s12909-023-04050-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Recently, Objective Structured Clinical Examinations (OSCE) became an official evaluation modality for 6-year medical students in France. Before, standard examination modalities were: written progressive clinical cases (PCC), written critical reading of scientific articles (CRA), and internship evaluation (IE). The aim of this study was to assess the performances of 6-year medical students in their final faculty tests by comparing OSCE-exams with standard examination modalities. METHODS This was a prospective observational study. We included all 6-year medical students in our university from 2020 to 2021. The endpoints were the scores obtained at the following final faculty tests during the 6th year of medical studies: OSCE-training, OSCE-exams, written PCC, written CRA, and IE. All scores were compared in a paired-analysis. RESULTS A total of 400 students were included in the study. No student was excluded in the final analysis. The mean scores obtained at the OSCE-exams were significantly different from those obtained at OSCE-training, PCC, CRA, and IE (12.6 ± 1.7, 11.7 ± 1.7, 13.4 ± 1.4, 13.2 ± 1.5, 14.7 ± 0.9, respectively; p < 0.001). OSCE-exams scores were moderately and significantly correlated with OSCE-training and PCC (Spearman rho coefficient = 0.4, p < 0.001); OSCE examination scores were lowly but significantly correlated with CRA and IE (Spearman rho coefficient = 0.3, p < 0.001). OSCE-scores significantly increased after an OSCE training session. CONCLUSION In our faculty, 6-year medical students obtained lower scores at OSCE exams compared to other standard evaluation modalities. The correlation was weak to moderate but significant. These results suggest that OSCE are not redundant with the other evaluation modalities. Interestingly, a single OSCE training session led to an improvement in OSCE scores underlining the importance of a specific training.
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Affiliation(s)
- Souhil Lebdai
- Urology Department, University Hospital of Angers, 49933 Angers cedex 9, Angers, France.
- Health Faculty, University of Angers, Angers, France.
- All'Sims Center for Simulation in Healthcare, University Hospital of Angers, Angers, France.
| | | | - Ludovic Martin
- Health Faculty, University of Angers, Angers, France
- All'Sims Center for Simulation in Healthcare, University Hospital of Angers, Angers, France
| | | | | | - Emmanuel Rineau
- Health Faculty, University of Angers, Angers, France
- All'Sims Center for Simulation in Healthcare, University Hospital of Angers, Angers, France
- Department of Anesthesia and Critical Care, University Hospital of Angers, Angers, France
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Azoyan L, Lombardi Y, Renaud MC, Duguet A, Georgin-Lavialle S, Cohen-Aubart F, Ibanez G, Steichen O. [Association between students' clinical performance and their success in the computerized national ranking tests: A single-center retrospective cohort study]. Rev Med Interne 2023; 44:5-11. [PMID: 35934597 DOI: 10.1016/j.revmed.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/04/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Before attending residency, 6th-year French medical students must validate a final examination including a practical clinical test in their faculty. However, the national ranking that determines their future specialty and region solely relies on a computerized knowledge test. Our goal was to investigate the association between the final faculty test and the national ranking test. METHODS In our faculty, the final examination includes a computerized theoretical test (similar to the national one) and a practical test: a standardized evaluation of semiology skills at the bedside and a standardized assessment of relational skills with role plays. The agreements between the national test and faculty computerized and practical tests were analyzed by intraclass correlation coefficients (ICC). RESULTS Data from 1806 students who underwent the three examinations from 2017 to 2021 were analyzed. There was a good agreement between the ranks in the faculty and national computerized tests: ICC 0.83 (95% CI 0.81-0.85). By contrast, the agreement between the ranks in the faculty practical test and the national computerized test was poor: ICC 0.13 (95% CI 0.08-0.17). Results were stable over the years. CONCLUSION The agreement between the ranking of the current national test and the clinical skills assessed by a specific faculty test is poor. This could relate to a true independence or to different levels of motivation to perform well. Indeed, the result of the national test is the most important one as it determines their career. Incorporating a clinical assessment into the national ranking test will motivate students to acquire clinical skills and value those who perform well this practical dimension.
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Affiliation(s)
- L Azoyan
- AP-HP, Hôpital Tenon, service de médecine interne, 4 rue de la Chine, 75020 Paris, France; Sorbonne Université, faculté de médecine, Paris, France.
| | - Y Lombardi
- AP-HP, Hôpital Tenon, soins intensifs néphrologiques et rein aigu, 4 rue de la Chine, 75020 Paris, France; Sorbonne Université, faculté de médecine, Paris, France
| | - M C Renaud
- Sorbonne Université, faculté de médecine, Paris, France
| | - A Duguet
- Sorbonne Université, faculté de médecine, Paris, France
| | - S Georgin-Lavialle
- AP-HP, Hôpital Tenon, service de médecine interne, 4 rue de la Chine, 75020 Paris, France; Sorbonne Université, faculté de médecine, Paris, France
| | - F Cohen-Aubart
- Sorbonne Université, faculté de médecine, Paris, France; AP-HP, Hôpital de la Pitié-Salpêtrière service de médecine interne 2, 47-83 boulevard de l'Hôpital, 75013 Paris, France
| | - G Ibanez
- Sorbonne Université, faculté de médecine, Paris, France; Sorbonne Université, département de médecine générale, Paris, France
| | - O Steichen
- AP-HP, Hôpital Tenon, service de médecine interne, 4 rue de la Chine, 75020 Paris, France; Sorbonne Université, faculté de médecine, Paris, France; INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, équipe Sentinelles, 27 rue de Chaligny, 75012 Paris, France
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Gripay B, André T, De Laval M, Peneau B, Secourgeon A, Lerolle N, Annweiler C, Justeau G, Connan L, Martin L, Bière L. Benefits of semiology taught using near-peer tutoring are sustainable. BMC MEDICAL EDUCATION 2022; 22:26. [PMID: 35012540 PMCID: PMC8744339 DOI: 10.1186/s12909-021-03086-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 12/06/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Near-peer tutoring appears to be an efficient approach for teaching clinical skills. However, the clinical experience gained in the form of student medical internships may offset any interest in such tutoring programme. We then investigated the long-term benefits of this programme. METHODS This study was conducted in a medical school that experimented in near-peer tutoring for semiology intended for undergraduate medical students. Objective Structured Clinical Examinations and a written semiology test were used to assess students' clinical skills immediately on its conclusion and repeated one and 2 years after the tutoring was completed. RESULTS 116 students were evaluated initially (80 tutored and 36 untutored), 38 at 1 year (16 tutored and 22 untutored), 42 at 2 years (21 tutored and 21 untutored). In the global score for Objective Structured Clinical Examinations: at 1 year, the tutored group scored 14.0 ± 1.05 and the untutored group scored 11.3 ± 2.3 (p < 0.001), at 2 years, the tutored group scored 15.1 ± 1.5 and the untutored group scored 12.4 ± 2.2 (p < 0.001). We found a similar but smaller difference for the written semiology test. The difference for Objective Structured Clinical Examinations between tutored and untutored students vanished over time for cross-cutting skills. CONCLUSIONS Near-peer tutoring in semiology for undergraduate medical students led to better results that remained with the passing of time. Though internships do allow an improvement in the clinical skills of untutored students, they did not reach the level of tutored students.
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Affiliation(s)
| | - Thomas André
- Faculty of Health, Univ Angers, 49000, Angers, France
| | | | - Brice Peneau
- Faculty of Health, Univ Angers, 49000, Angers, France
| | | | - Nicolas Lerolle
- Faculty of Health, Univ Angers, 49000, Angers, France
- All'Sims Centre for Simulation in Healthcare, Faculty of Health, University Hospital of Angers, 49000, Angers, France
| | | | - Grégoire Justeau
- Faculty of Health, Univ Angers, 49000, Angers, France
- All'Sims Centre for Simulation in Healthcare, Faculty of Health, University Hospital of Angers, 49000, Angers, France
| | | | - Ludovic Martin
- Faculty of Health, Univ Angers, 49000, Angers, France
- All'Sims Centre for Simulation in Healthcare, Faculty of Health, University Hospital of Angers, 49000, Angers, France
| | - Loïc Bière
- Faculty of Health, Univ Angers, 49000, Angers, France.
- All'Sims Centre for Simulation in Healthcare, Faculty of Health, University Hospital of Angers, 49000, Angers, France.
- School of Medicine, University Hospital of Angers, 28 rue Roger-Amsler, 49045, Angers Cedex 01, France.
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Matet A, Fournel L, Gaillard F, Amar L, Arlet JB, Baron S, Bats AS, Buffel du Vaure C, Charlier C, De Lastours V, Faye A, Jablon E, Kadlub N, Leguen J, Lebeaux D, Malmartel A, Mirault T, Planquette B, Régent A, Thebault JL, Dinh AT, Nuzzo A, Turc G, Friedlander G, Ruszniewski P, Badoual C, Ranque B, Oualha M, Courbebaisse M. Impact of integrating objective structured clinical examination into academic student assessment: Large-scale experience in a French medical school. PLoS One 2021; 16:e0245439. [PMID: 33444375 PMCID: PMC7808634 DOI: 10.1371/journal.pone.0245439] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/01/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose Objective structured clinical examinations (OSCE) evaluate clinical reasoning, communication skills, and interpersonal behavior during medical education. In France, clinical training has long relied on bedside clinical practice in academic hospitals. The need for a simulated teaching environment has recently emerged, due to the increasing number of students admitted to medical schools, and the necessity of objectively evaluating practical skills. This study aimed at investigating the relationships between OSCE grades and current evaluation modalities. Methods Three-hundred seventy-nine 4th-year students of University-of-Paris Medical School participated to the first large-scale OSCE at this institution, consisting in three OSCE stations (OSCE#1–3). OSCE#1 and #2 focused on cardiovascular clinical skills and competence, whereas OSCE#3 focused on relational skills while providing explanations before planned cholecystectomy. We investigated correlations of OSCE grades with multiple choice (MCQ)-based written examinations and evaluations of clinical skills and behavior (during hospital traineeships); OSCE grade distribution; and the impact of integrating OSCE grades into the current evaluation in terms of student ranking. Results The competence-oriented OSCE#1 and OSCE#2 grades correlated only with MCQ grades (r = 0.19, P<0.001) or traineeship skill grades (r = 0.17, P = 0.001), respectively, and not with traineeship behavior grades (P>0.75). Conversely, the behavior-oriented OSCE#3 grades correlated with traineeship skill and behavior grades (r = 0.19, P<0.001, and r = 0.12, P = 0.032), but not with MCQ grades (P = 0.09). The dispersion of OSCE grades was wider than for MCQ examinations (P<0.001). When OSCE grades were integrated to the final fourth-year grade with an incremental 10%, 20% or 40% coefficient, an increasing proportion of the 379 students had a ranking variation by ±50 ranks (P<0.001). This ranking change mainly affected students among the mid-50% of ranking. Conclusion This large-scale French experience showed that OSCE designed to assess a combination of clinical competence and behavioral skills, increases the discriminatory capacity of current evaluations modalities in French medical schools.
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Affiliation(s)
- Alexandre Matet
- Université de Paris, Faculté de Médecine, Paris, France
- Centre de Recherche des Cordeliers, INSERM UMR1138, Paris, France
- Service d’ophtalmologie, Institut Curie, Paris, France
- * E-mail:
| | - Ludovic Fournel
- Université de Paris, Faculté de Médecine, Paris, France
- INSERM UMR1124, Paris, France
- Service de chirurgie thoracique, AP-HP, Hôpital Cochin, Paris, France
| | - François Gaillard
- Département de physiologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Laurence Amar
- Université de Paris, Faculté de Médecine, Paris, France
- PARCC INSERM U970, Paris, France
- Département d’hypertension artérielle, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Jean-Benoit Arlet
- Université de Paris, Faculté de Médecine, Paris, France
- Service de Médecine interne, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Stéphanie Baron
- Université de Paris, Faculté de Médecine, Paris, France
- Département de physiologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Anne-Sophie Bats
- Université de Paris, Faculté de Médecine, Paris, France
- INSERM UMR-S 1147, Paris, France
- Service de gynécologie oncologique et de chirurgie du sein, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Celine Buffel du Vaure
- Département de médecine générale, Université de Paris, Faculté de Médecine, Paris, France
| | - Caroline Charlier
- Université de Paris, Faculté de Médecine, Paris, France
- Institut Pasteur, INSERM U1117, Paris, France
- Département de maladies infectieuses et tropicales, AP-HP, Hôpital Universitaire Necker, Paris, France
| | - Victoire De Lastours
- Université de Paris, Faculté de Médecine, Paris, France
- IAME, UMR1137, INSERM, Paris, France
- Service de Médecine Interne, AP-HP, Hôpital Beaujon, Clichy, France
| | - Albert Faye
- Université de Paris, Faculté de Médecine, Paris, France
- Service de Pédiatrie Générale, Hôpital Robert Debré, Paris, INSERM ECEVE 1123, Paris, France
| | - Eve Jablon
- Service AGIR, Université de Paris, Faculté de Médecine, Paris, France
| | - Natacha Kadlub
- Université de Paris, Faculté de Médecine, Paris, France
- Département de chirurgie maxillo-faciale et de chirurgie plastique, AP-HP, Hôpital Universitaire Necker, Paris, France
| | - Julien Leguen
- Université de Paris, Faculté de Médecine, Paris, France
- Service de Gériatrie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - David Lebeaux
- Université de Paris, Faculté de Médecine, Paris, France
- Département de Microbiologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Alexandre Malmartel
- Département de médecine générale, Université de Paris, Faculté de Médecine, Paris, France
| | - Tristan Mirault
- Université de Paris, Faculté de Médecine, Paris, France
- PARCC INSERM U970, Paris, France
- Département d’hypertension artérielle, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Benjamin Planquette
- Université de Paris, Faculté de Médecine, Paris, France
- INSERM UMR S1140, Paris, France
- Service de Pneumologie et de soins intensifs, AH-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Alexis Régent
- Université de Paris, Faculté de Médecine, Paris, France
- Institut Cochin, INSERM U1016, CNRS UMR 8104, LabEx INFLAMEX, Paris, France
- Service de Médecine Interne, Centre de Référence pour les Maladies Systémiques Auto immunes Rares d’Ile-de-France, AP-HP, Hôpital Cochin, Paris, France
| | - Jean-Laurent Thebault
- Département de médecine générale, Université de Paris, Faculté de Médecine, Paris, France
| | - Alexy Tran Dinh
- Université de Paris, Faculté de Médecine, Paris, France
- INSERM U1148 LVTS, Villetanneuse, France
- Département d'Anesthésie-Réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Alexandre Nuzzo
- Université de Paris, Faculté de Médecine, Paris, France
- Service de gastro-entérologie et pancréatologie, AP-HP, Hôpital Beaujon, Paris, France
| | - Guillaume Turc
- Université de Paris, Faculté de Médecine, Paris, France
- INSERM U1266, Paris, France
- Service de neurologie, Hôpital Sainte Anne, AH-HP, Paris, France
| | - Gérard Friedlander
- Université de Paris, Faculté de Médecine, Paris, France
- Département de physiologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
- Institut Necker-Enfants Malades, INSERM U1151-CNRS UMR8253, Paris, France
| | - Philippe Ruszniewski
- Université de Paris, Faculté de Médecine, Paris, France
- INSERM U1266, Paris, France
- INSERM UMR1149, Paris, France
| | - Cécile Badoual
- Université de Paris, Faculté de Médecine, Paris, France
- PARCC INSERM U970, Paris, France
- Service d’anatomopathologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Brigitte Ranque
- Université de Paris, Faculté de Médecine, Paris, France
- PARCC INSERM U970, Paris, France
- Service de Médecine interne, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Mehdi Oualha
- Université de Paris, Faculté de Médecine, Paris, France
- Unité EA7323, Université de Paris, Faculté de Médecine, Paris, France
- Service de réanimation et de surveillance continue médico-chirurgicale pédiatrique, AP-HP, Hôpital Universitaire Necker, Paris, France
| | - Marie Courbebaisse
- Université de Paris, Faculté de Médecine, Paris, France
- Département de physiologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
- Institut Necker-Enfants Malades, INSERM U1151-CNRS UMR8253, Paris, France
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Sederberg M, Liem B, Tarkhan A, Gessel T, LaCourse M, Latzka E. Brief Ultrasound-Aided Teaching to Improve the Accuracy and Confidence of Resident Musculoskeletal Palpation. PM R 2019; 12:391-396. [PMID: 31448538 DOI: 10.1002/pmrj.12246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 08/18/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Multiple studies demonstrate poor musculoskeletal palpation accuracy of physiatry residents. With the growing use of ultrasound clinically, it could serve as a powerful educational tool. However, there are no published studies examining the efficacy of ultrasound-aided education at the bedside, where much learning takes place during postgraduate training. OBJECTIVE To determine if brief ultrasound-aided teaching improves residents' accuracy and confidence of musculoskeletal palpation. DESIGN Before/After Trial. SETTING Academic Institution. PARTICIPANTS Ten physical medicine and rehabilitation residents were voluntary participants. INTERVENTION Each resident was given a survey to assess confidence in palpating the hook of the hamate and medial calcaneal tubercle. They then attempted to palpate and place a marker over these two structures in a model patient. Marker placement accuracy was verified by ultrasound. Faculty spent less than 1 minute per landmark, sonographically teaching its correct localization. The resident, after moving to a new model patient, was then re-tested on accurate marker placement for both landmarks. A repeat survey to assess confidence was administered. MAIN OUTCOME MEASUREMENTS Preintervention and postintervention accuracy and confidence of correct localization of both landmarks. RESULTS We used McNemar's and Wilcoxon's tests to determine whether the intervention improved the location accuracy and confidence of successful palpation, respectively. Confidence level of correct localization of two landmarks improved on average from 4.3 to 8.15 on a scale of 10 after intervention. Of 20 palpation attempts, 11 correctly placed the marker postintervention after an incorrect placement, 8 made no change, and one changed from correct to incorrect placement. The odds of improvement in accuracy was 11 (95% confidence interval [CI] 1.60-473.47, P < .01). Both tests showed significant improvements after the intervention at the significance level of .05. CONCLUSIONS Brief, ultrasound-aided teaching increases accuracy and confidence of residents' musculoskeletal palpation.
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Affiliation(s)
- Mark Sederberg
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Brian Liem
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | | | - Trevor Gessel
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Matthew LaCourse
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Erek Latzka
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
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Pham-Dinh C, Laprevote V, Schwan R, Pichené C, Kabuth B, Braun M, Ligier F. Quantifying efficacy of investigation during a simulated psychiatric interview. Encephale 2019; 46:96-101. [PMID: 31522835 DOI: 10.1016/j.encep.2019.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/27/2019] [Accepted: 07/18/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Simulation is a very promising educational tool. It provides medical students with clinical experience without jeopardizing patients' health. This tool can be implemented in psychiatry training in order to develop interview and specific assessment skills which is why the Université de Lorraine relies increasingly on simulation in teaching psychiatry to its residents. However, there are few objective indicators in that field that make it possible to assess learners. This study aims to assess the relevance of a quantitative measure for objectivising the investigation efficiency by psychiatry residents of a suicidal risk during a simulated psychiatric interview. METHODS A simulation exercise was offered to 20 psychiatric trainees from the Université de Lorraine. Their mission was to identify relevant information for assessing and guiding a standardized patient with suicidal risk during a psychiatric interview. The key judgemental criterion was the I2/Q ratio which corresponds to the squared number of relevant items collected by the interviewer divided by the number of questions. When dealing with emergency cases it is indeed important to collect as many key items in as little time as possible. This score was assessed by two examiners based on the analysis of filmed interviews. RESULTS The mean I2/Q ratio was 1.13 (SEM±0.2) and ranged between 0.25 and 2.86. Statistical analysis showed a positive correlation between I2/Q ratio and students' clinical experience (R=0.46, P=0.04). The interclass correlation coefficient (ICC) of the I2/Q ratio between the two examiners was 0.94. CONCLUSION I2/Q ratio may provide a consistent quantitative measure of a student's efficiency in assessing suicidal risk. Further research is now needed to evaluate its consistency in other clinical cases.
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Affiliation(s)
- C Pham-Dinh
- Centre hospitalier de Lorquin, 57790 Lorquin, France
| | - V Laprevote
- Centre psychothérapique de Nancy, 1, rue du Dr-Archambault, 54520 Lorraine, Laxou, France; EA 7298, INGRES, Université de Lorraine, 54000 Vandœuvre-lès-Nancy, France
| | - R Schwan
- Centre psychothérapique de Nancy, 1, rue du Dr-Archambault, 54520 Lorraine, Laxou, France; Faculté de médecine de Nancy, université de Lorraine, 54000 Nancy, France
| | - C Pichené
- Centre psychothérapique de Nancy, 1, rue du Dr-Archambault, 54520 Lorraine, Laxou, France
| | - B Kabuth
- Centre psychothérapique de Nancy, 1, rue du Dr-Archambault, 54520 Lorraine, Laxou, France; Faculté de médecine de Nancy, université de Lorraine, 54000 Nancy, France
| | - M Braun
- Faculté de médecine de Nancy, université de Lorraine, 54000 Nancy, France
| | - F Ligier
- Centre psychothérapique de Nancy, 1, rue du Dr-Archambault, 54520 Lorraine, Laxou, France; EA 4360 APEMAC, Équipe MICS, Université de Lorraine, 54000 Nancy, France.
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Turc G, Terrier B, Bats AS, Ngo C, Ranque B, Calvet D. [Acquisition of clinical observation skills by medical students improves with discipline-based teaching. The example of neurological examination]. Rev Med Interne 2018; 39:905-911. [PMID: 30290964 DOI: 10.1016/j.revmed.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 09/04/2018] [Accepted: 09/11/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Since 2014-2015, practical teaching of clinical observation skills for 2nd year medical students at our faculty has been discipline-based; previously, each clinical lecturer had to cover all medical fields. We assessed the impact of this teaching reform on the neurological examination skills of medical students in a before-and-after study. METHODS Pre-reform 3rd and post-reform 2nd and 3rd year medical students (n=62, n=71 and 52, respectively) had to perform 7 neurological examination items, for which performance criteria had been pre-defined. Subsequently, we assessed whether the mean grade in neurological examination skills during the test at the end of the 2nd year was different between students who had received neurological teaching from a neurologist (n=29) or another specialist (n=102). RESULTS The median [interquartile range] number of items acquired by post-reform 3rd year students (4 [2-5]) was higher than that of pre-reform 3rd year students (2 [1-3]; P<0.001), but lower than that of post-reform 2nd year students (5 [4-6]; P=0.01). The mean grade obtained during the practical test was not different in students trained by a neurologist or another specialist. CONCLUSION Acquisition of neurological examination skills improved after the teaching reform which consisted of: (1) a discipline-based practical teaching of clinical observation skills; (2) a training of clinical lecturers to teach a limited list of educational objectives; and (3) the introduction of a practical test at the end of the 2nd year of medical studies. However, there was a decline in clinical observation skills between 2nd and 3rd year medical students.
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Affiliation(s)
- G Turc
- Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, 15, rue de l'École-de-médecine, 75006 Paris, France; Service de neurologie, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France; Unité Inserm U894, centre de psychiatrie et neurosciences, Paris, France
| | - B Terrier
- Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, 15, rue de l'École-de-médecine, 75006 Paris, France; Service de médecine interne, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - A-S Bats
- Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, 15, rue de l'École-de-médecine, 75006 Paris, France; Service de chirurgie cancérologique gynécologique et du sein, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20-40, rue Leblanc, 75015 Paris, France
| | - C Ngo
- Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, 15, rue de l'École-de-médecine, 75006 Paris, France; Service de chirurgie cancérologique gynécologique et du sein, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20-40, rue Leblanc, 75015 Paris, France
| | - B Ranque
- Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, 15, rue de l'École-de-médecine, 75006 Paris, France; Service de médecine interne, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20-40, rue Leblanc, 75015 Paris, France
| | - D Calvet
- Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, 15, rue de l'École-de-médecine, 75006 Paris, France; Service de neurologie, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France; Unité Inserm U894, centre de psychiatrie et neurosciences, Paris, France.
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8
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[Simulation-based learning and internal medicine: Opportunities and current perspectives for a national harmonized program]. Rev Med Interne 2018; 39:414-420. [PMID: 29548580 DOI: 10.1016/j.revmed.2017.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 11/09/2017] [Accepted: 11/25/2017] [Indexed: 11/19/2022]
Abstract
Simulation-based learning (SBL) is developing rapidly in France and the question of its use in the teaching of internal medicine (IM) is essential. While HAS encourages its integration into medical education, French Young Internists (AJI) set up a working group to reflect on the added-value of this tool in our specialty. Different sorts of SBL exist: human, synthetic and electronic. It enables student to acquire and evaluate technical skills (strengths, invasive procedures, etc.) and non-technical skills (relational, reasoning…). The debriefing that follows the simulation session is an essential time in pedagogical terms. It enables the acquisition of knowledge by encouraging the students' reflection to reshape their reasoning patterns by self-correcting. IM interns are supportive of its use. The simulation would allow young internists to acquire skills specific to our specialty such as certain gestures, complex consulting management, the synthesis of difficult clinical cases. SBL remains confronted with human and financial cost issues. The budgets allocated to the development and maintenance of simulation centres are uneven, making the supply of training unequal on the territory. Simulation sessions are time-consuming and require teacher training. Are faculties ready to train and invest their time in simulation, even though the studies do not allow us to conclude on its pedagogical validity?
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9
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Samson M, Terrier B, Mangin O, Mouthon L. [Inventory of training of internal medicine in France: Results of a national survey]. Rev Med Interne 2016; 38:300-306. [PMID: 27889326 DOI: 10.1016/j.revmed.2016.10.385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 09/01/2016] [Accepted: 10/20/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To make an inventory of training of Internal Medicine in France. METHOD This study was conducted between May and September 2015 with coordinators (interviews of 45minutes) of local Internal Medicine training and fellows (online questionnaire). RESULTS All coordinators (n=28) responded to the interviews. Local training of Internal Medicine exists in 86% of regions (3.1±3.1hours/month) and an interregional training in all interregions (34.7±13.9hours/year). When excluding Île-de-France, no correlation between the number of teachers and the amount of lessons was noted (P=0.61). Of the 550 fellows in Internal Medicine in 2014-2015, 223 (41%) responded to the online questionnaire. Mean level was 5.5±2.7 semesters. The rate of satisfaction (1=very dissatisfied and 5=very satisfied) was 3.0±1.0 and 3.8±0.8 for regional and interregional teaching, respectively (P<0.0001). Regional teaching satisfaction was correlated with the perceived expanse of diseases covered into the program (P<0.0001). In addition, 89% of fellows wish to evaluate themselves online, 66% wish to have a practical evaluation at the bedside and 70% in simulation centers. Finally, 91% of fellows support the establishment of a national program for the training of Internal Medicine. CONCLUSION This survey states for the first time an inventory of training of Internal Medicine dedicated to fellows in France. This report highlights that fellows wish to have a national program, be further evaluated and have access to more interactive approach of teaching.
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Affiliation(s)
- M Samson
- Service de médecine interne et immunologie clinique, hôpital François-Mitterrand, CHU de Dijon, Dijon, France
| | - B Terrier
- Service de médecine interne, hôpital Cochin, Assistance publique-Hôpitaux de Paris, université Paris-Descartes, faculté de médecine, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - O Mangin
- Service de médecine interne, hôpital Cochin, Assistance publique-Hôpitaux de Paris, université Paris-Descartes, faculté de médecine, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - L Mouthon
- Service de médecine interne, hôpital Cochin, Assistance publique-Hôpitaux de Paris, université Paris-Descartes, faculté de médecine, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
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10
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Roze E, Flamand-Roze C, Méneret A, Ruiz M, Le Liepvre H, Duguet A, Renaud MC, Alamowitch S, Steichen O. ‘The Move’, an innovative simulation-based medical education program using roleplay to teach neurological semiology: Students’ and teachers’ perceptions. Rev Neurol (Paris) 2016; 172:289-94. [DOI: 10.1016/j.neurol.2016.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 02/29/2016] [Indexed: 10/22/2022]
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11
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Roux D, Meyer G, Cymbalista F, Bouaziz JD, Falgarone G, Tesniere A, Gervais J, Cariou A, Peffault de Latour R, Marat M, Moenaert E, Guebli T, Rodriguez O, Lefort A, Dreyfuss D, Hajage D, Ricard JD. [Computerized ranking test in three French universities: Staff experience and students' feedback]. Rev Med Interne 2016; 37:166-72. [PMID: 26827272 DOI: 10.1016/j.revmed.2015.12.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 11/26/2015] [Accepted: 12/29/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The year 2016 will be pivotal for the evaluation of French medical students with the introduction of the first computerized National Ranking Test (ECNi). The SIDES, online electronic system for medical student evaluation, was created for this purpose. All the universities have already organized faculty exams but few a joint computerized ranking test at several universities simultaneously. We report our experience on the organization of a mock ECNi by universities Paris Descartes, Paris Diderot and Paris 13. METHODS Docimological, administrative and technical working groups were created to organize this ECNi. Students in their fifth year of medical studies, who will be the first students to sit for the official ECNi in 2016, were invited to attend this mock exam that represented more than 50% of what will be proposed in 2016. A final electronic questionnaire allowed a docimological and organizational evaluation by students. An analysis of ratings and rankings and their distribution on a 1000-point scale were performed. RESULTS Sixty-four percent of enrolled students (i.e., 654) attended the three half-day exams. No difference in total score and ranking between the three universities was observed. Students' feedback was extremely positive. Normalized over 1000 points, 99% of students were scored on 300 points only. Progressive clinical cases were the most discriminating test. CONCLUSION The organization of a mock ECNi involving multiple universities was a docimological and technical success but required an important administrative, technical and teaching investment.
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Affiliation(s)
- D Roux
- Université Paris Diderot, Sorbonne Paris Cité, 75205 Paris, France; Service de réanimation médicochirurgicale, hôpital Louis-Mourier, AP-HP, 178, rue des Renouillers, 92700 Colombes, France.
| | - G Meyer
- Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France; Service de pneumologie, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - F Cymbalista
- Université Paris 13, Sorbonne Paris Cité, 93000 Bobigny, France; Service d'hématologie biologique, hôpital Avicenne, AP-HP, 93000 Bobigny, France
| | - J-D Bouaziz
- Université Paris Diderot, Sorbonne Paris Cité, 75205 Paris, France; Service de dermatologie, hôpital Saint-Louis, AP-HP, 75010 Paris, France
| | - G Falgarone
- Université Paris 13, Sorbonne Paris Cité, 93000 Bobigny, France; Service de rhumatologie, hôpital Avicenne, AP-HP, 93000 Bobigny, France
| | - A Tesniere
- Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France; Service de réanimation chirurgicale, hôpital Cochin, AP-HP, 74014 Paris, France
| | - J Gervais
- Université Paris Diderot, Sorbonne Paris Cité, 75205 Paris, France
| | - A Cariou
- Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France; Service de réanimation médicale, hôpital Cochin, AP-HP, 74014 Paris, France
| | - R Peffault de Latour
- Université Paris Diderot, Sorbonne Paris Cité, 75205 Paris, France; Service d'hématologie greffe, hôpital Saint-Louis, AP-HP, 75010 Paris, France
| | - M Marat
- Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France
| | - E Moenaert
- Université Paris Diderot, Sorbonne Paris Cité, 75205 Paris, France
| | - T Guebli
- Université Paris 13, Sorbonne Paris Cité, 93000 Bobigny, France
| | - O Rodriguez
- Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France
| | - A Lefort
- Université Paris Diderot, Sorbonne Paris Cité, 75205 Paris, France; Service de médecine interne, hôpital Beaujon, AP-HP, 92110 Clichy, France
| | - D Dreyfuss
- Université Paris Diderot, Sorbonne Paris Cité, 75205 Paris, France; Service de réanimation médicochirurgicale, hôpital Louis-Mourier, AP-HP, 178, rue des Renouillers, 92700 Colombes, France
| | - D Hajage
- Université Paris Diderot, Sorbonne Paris Cité, 75205 Paris, France; Département d'épidémiologie et de recherche clinique, hôpital Louis-Mourier, AP-HP, 92700 Colombes, France
| | - J-D Ricard
- Université Paris Diderot, Sorbonne Paris Cité, 75205 Paris, France; Service de réanimation médicochirurgicale, hôpital Louis-Mourier, AP-HP, 178, rue des Renouillers, 92700 Colombes, France
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