The effectiveness of a first-year clinical preceptorship on the data collection and communication skills of second-year medical students

Teaching "medical interview and physical examination" from the very beginning of medical school and using "escape rooms" during the final assessment: achievements and educational impact in Japan

BACKGROUND

There is no consensus regarding the best time to teach two fundamental pillars of clinical medicine: medical interview and physical examination. We investigated the impacts of teaching the course "Medical Interview and Physical Examination" in Japan from the very beginning of medical school. In addition, we also evaluated the educational value of using "Escape Rooms", a series of timed, game-based scenarios using simulators, as a part of the final assessment of the course.

METHODS

At the end of the course, the interview capabilities of 140 first year medical students at International University of Health and Welfare (Japan) were assessed by physicians who acted as simulated patients. Physical examination skills were assessed using the "Escape Room" team task method. Students also self-assessed their confidence in their physical examination skills pre and post "Escape Rooms." A day prior to the final assessment, students completed an anonymous course evaluation.

RESULTS

The average global rating of the students' medical interview skills using a rating scale from 1 to 6 (1-fail 6-outstanding, no different from practicing junior physician's level) was 4.6. Twenty-two students scored the highest mark of 6. An average of 89% of "Escape Room" teams finished all the physical examination tasks correctly within the allotted time. All teams that could not finish in time completed all tasks correctly when given an additional 3 to 5 min. Students' self-assessed confidence in their physical examination skills increased from 49 to 73 (out of 100) pre and post "Escape Rooms." In the course evaluation questionnaire, 99% of students answered "this course enhanced their motivation" (response rate 89%) and 99% also answered "this course was interesting and useful" (response rate 86%).

CONCLUSIONS

This descriptive study analyzing both quantitative and qualitative data showed that the course not only achieved the intended objectives of successfully conducting comprehensive medical interview and basic physical examination skills, but also enhanced student motivation. "Escape Rooms", used for the course assessment, in itself enhanced students' self-perceived physical examination skills and had an added educational value.

Interventions for improving medical students' interpersonal communication in medical consultations

BACKGROUND

Communication is a common element in all medical consultations, affecting a range of outcomes for doctors and patients. The increasing demand for medical students to be trained to communicate effectively has seen the emergence of interpersonal communication skills as core graduate competencies in medical training around the world. Medical schools have adopted a range of approaches to develop and evaluate these competencies.

OBJECTIVES

To assess the effects of interventions for medical students that aim to improve interpersonal communication in medical consultations.

SEARCH METHODS

We searched five electronic databases: Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO, and ERIC (Educational Resource Information Centre) in September 2020, with no language, date, or publication status restrictions. We also screened reference lists of relevant articles and contacted authors of included studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), cluster-RCTs (C-RCTs), and non-randomised controlled trials (quasi-RCTs) evaluating the effectiveness of interventions delivered to students in undergraduate or graduate-entry medical programmes. We included studies of interventions aiming to improve medical students' interpersonal communication during medical consultations. Included interventions targeted communication skills associated with empathy, relationship building, gathering information, and explanation and planning, as well as specific communication tasks such as listening, appropriate structure, and question style.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. Two review authors independently reviewed all search results, extracted data, assessed the risk of bias of included studies, and rated the quality of evidence using GRADE.

MAIN RESULTS

We found 91 publications relating to 76 separate studies (involving 10,124 students): 55 RCTs, 9 quasi-RCTs, 7 C-RCTs, and 5 quasi-C-RCTs. We performed meta-analysis according to comparison and outcome. Among both effectiveness and comparative effectiveness analyses, we separated outcomes reporting on overall communication skills, empathy, rapport or relationship building, patient perceptions/satisfaction, information gathering, and explanation and planning. Overall communication skills and empathy were further divided as examiner- or simulated patient-assessed. The overall quality of evidence ranged from moderate to very low, and there was high, unexplained heterogeneity. Overall, interventions had positive effects on most outcomes, but generally small effect sizes and evidence quality limit the conclusions that can be drawn. Communication skills interventions in comparison to usual curricula or control may improve both overall communication skills (standardised mean difference (SMD) 0.92, 95% confidence interval (CI) 0.53 to 1.31; 18 studies, 1356 participants; I² = 90%; low-quality evidence) and empathy (SMD 0.64, 95% CI 0.23 to 1.05; 6 studies, 831 participants; I² = 86%; low-quality evidence) when assessed by experts, but not by simulated patients. Students' skills in information gathering probably also improve with educational intervention (SMD 1.07, 95% CI 0.61 to 1.54; 5 studies, 405 participants; I² = 78%; moderate-quality evidence), but there may be little to no effect on students' rapport (SMD 0.18, 95% CI -0.15 to 0.51; 9 studies, 834 participants; I² = 81%; low-quality evidence), and effects on information giving skills are uncertain (very low-quality evidence). We are uncertain whether experiential interventions improve overall communication skills in comparison to didactic approaches (SMD 0.08, 95% CI -0.02 to 0.19; 4 studies, 1578 participants; I² = 4%; very low-quality evidence). Electronic learning approaches may have little to no effect on students' empathy scores (SMD -0.13, 95% CI -0.68 to 0.43; 3 studies, 421 participants; I² = 82%; low-quality evidence) or on rapport (SMD 0.02, 95% CI -0.33 to 0.38; 3 studies, 176 participants; I² = 19%; moderate-quality evidence) compared to face-to-face approaches. There may be small negative effects of electronic interventions on information giving skills (low-quality evidence), and effects on information gathering skills are uncertain (very low-quality evidence).  Personalised/specific feedback probably improves overall communication skills to a small degree in comparison to generic or no feedback (SMD 0.58, 95% CI 0.29 to 0.87; 6 studies, 502 participants; I² = 56%; moderate-quality evidence). There may be small positive effects of personalised feedback on empathy and information gathering skills (low quality), but effects on rapport are uncertain (very low quality), and we found no evidence on information giving skills. We are uncertain whether role-play with simulated patients outperforms peer role-play in improving students' overall communication skills (SMD 0.17, 95% CI -0.33 to 0.67; 4 studies, 637 participants; I² = 87%; very low-quality evidence). There may be little to no difference between effects of simulated patient and peer role-play on students' empathy (low-quality evidence) with no evidence on other outcomes for this comparison. Descriptive syntheses of results that could not be included in meta-analyses across outcomes and comparisons were mixed, as were effects of different interventions and comparisons on specific communication skills assessed by the included trials. Quality of evidence was downgraded due to methodological limitations across several risk of bias domains, high unexplained heterogeneity, and imprecision of results. In general, results remain consistent in sensitivity analysis based on risk of bias and adjustment for clustering. No adverse effects were reported.  AUTHORS' CONCLUSIONS: This review represents a substantial body of evidence from which to draw, but further research is needed to strengthen the quality of the evidence base, to consider the long-term effects of interventions on students' behaviour as they progress through training and into practice, and to assess effects of interventions on patient outcomes. Efforts to standardise assessment and evaluation of interpersonal skills will strengthen future research efforts.

When and How Pediatric History and Physical Diagnosis Are Taught in Medical School: A Survey of Pediatric Clerkship Directors

Backround:

History and physical diagnosis skills (HPDS) are required curriculum in medical schools (MS) with pediatric HPDS (PHPDS) necessitating instruction in addition to adult HPDS. Perceived deficiencies in these skills on the pediatric clerkship prompted investigation of when and how other MS taught PHPDS. The concern of whether medical students are adequately taught PHPDS needed to be addressed.

Methods:

With the use of the Council on Medical Student Education in Pediatrics listserv, pediatric clerkship directors from 129 US, 15 Canadian, and 2 Puerto Rican MS were contacted via e-mail to complete an anonymous online questionnaire, focused on MS demographics, PHPDS timing, teaching methods, and barriers.

Results:

Seventy-two (49%) of 146 MS responded to the survey; 18.1% of MS responders did not offer PHPDS in the first 2 years. Methodologies used to educate students included didactic lectures, physician shadowing, hands-on with patients, pairing with preceptor, instructional video, and examination of newborns. Each teaching method had <3 hours dedicated to medical students during their first 2 years at a majority of the MS. Of the responders, 85.1% concurred that medical students should be exposed to PHPDS before starting the clerkship. Barriers to providing PHPDS included MS time allotment, preceptor availability, and total number of students to accommodate.

Conclusions:

This study demonstrated striking variability among MS in how and when medical students were taught PHPDS. Clarification of the role of PHPDS instruction in preclinical years and standardized effective approaches to PHPDS instruction are both needed so that MS curriculum optimizes physician training.

Understanding the educational value of first-year medical students' patient encounter data

BACKGROUND

Many medical schools use patient-encounter logs to track students' clinical experiences, but few have investigated the student-user perspective to understand how students enter, review, and use patient-encounter information.

AIMS

This study examines first-year medical students' use of a web-based tracking system and whether students thought logging patient-encounters was educationally valuable.

METHODS

This mixed-methods study uses data from student encounter log entries, a focus group with first-year students, and a survey. Data analysis involved descriptive statistics for quantitative data, qualitative content analysis of students' free-response entries in the logs, and thematic analysis for focus group and survey responses.

RESULTS

Most students logged at least one encounter (90%), but used the system substantially less than expected. Focus group and survey data indicated that students found minimal educational value in the encounter tracking system as designed, but identified several ways in which the system could be improved to better support their learning. Suggestions included clearer guidelines for use, better integration into the curriculum, a mentoring process, and provision of benchmarks or target number of specific encounter types.

CONCLUSION

Student-user perspectives are crucial in optimizing information collected through patient-encounter tracking systems, and can improve both the functionality and the educational value of such systems.

Proceedings of the 2008 Annual Predoctoral Education Conference of the Society of Teachers of Family Medicine (STFM)

The Society of Teachers of Family Medicine (STFM; http://www.stfm.org) is a community of professionals devoted to teaching family medicine through undergraduate, graduate, and continuing medical education. This multidisciplinary group of physicians, educators, behavioral scientists, and researchers works to further STFM's mission of improving the health of all people through education, research, patient care, and advocacy. STFM holds an annual conference each spring and a predoctoral education conference each winter. STFM held its 34th Predoctoral Education Conference in Portland, Oregon, from January 24 to 27, 2008. The theme was "Igniting Students' Passion for Serving the Underserved." Christine Stabler, MD, Lancaster General Hospital, Lancaster, Pennsylvania, opened the conference with a plenary presentation on the passion for patient care, medical education, and advocacy that have defined her own career and continue to inspire medical trainees. Kenneth Ginsburg, MD, The Children's Hospital of Philadelphia and the University of Pennsylvania, continued the theme of igniting students' passion by exploring the ways in which socialization in medical education can teach students to suppress their feelings and humorously illustrated how accessing a full range of emotions can lead to satisfying lives and practices. Tanya Page, MD, a recent residency graduate practicing in a homeless clinic in Portland, Oregon, described her own passion for caring for the underserved. Participants shared ideas and learned new skills in more than 65 workshops, seminars, and discussions as well as 65 educational research and curriculum evaluation papers. The unifying theme was incorporating care of the underserved in medical education. From the educational research or curriculum evaluation papers presented at the conference, the STFM Education Committee selected 8 papers felt to be of interest to readers of Teaching and Learning in Medicine.

Further challenges in measuring communication skills: accounting for actor effects in standardised patient assessments

CONTEXT

Subjective rating scales for communication skills may yield more personally meaningful responses than more standardised rating schemes. It is unclear, however, whether such evaluations may be overly biased by respondents' rating styles, which may lead to unreliable measurement of examinees' communication skills.

METHODS

Our study involved 212 students from the classes of 2005 and 2006 at the University of Rochester School of Medicine and Dentistry. All students were rated by actors depicting standardised patients (SPs) on the same seven cases using the 19-item Rochester Communication Rating Scale (RCRS). Different students were assigned to different actors playing the same SP. We assessed the extent to which actors' personal rating styles influenced the scores they assigned to students. Main outcome measures were: between-actor variability in responses; the degree to which actors' response styles contribute to overall scores, and improvements in reliability achieved by standardising actors' ratings.

RESULTS

There were statistically significant differences between actors in their mean assigned scores. Scores aggregated over 18 separate SP cases have an expected generalisability coefficient of 0.79. If raw RCRS scores are used, a total of 27 replications of the RCRS are required to achieve a Cronbach's alpha of 0.8; standardisation reduces this number to 18.

CONCLUSIONS

Although actors are variable in their use of a standardised subjective scale of communication, such differences contribute to an acceptably small proportion of the total variance if scores are combined across a large number of cases. Reliability can be markedly improved by standardising scores across raters.