Classroom teaching with simulated patients during COVID-19: the communication skills course in the second year of the model medical curriculum HannibaL

Clinical experience can compensate for inferior academic achievements in an undergraduate objective structured clinical examination

BACKGROUND

Practical and non-cognitive skills are essential to medical professions; yet, success in medical studies is primarily assessed with cognitive criteria. We show that practical exams can benefit students who have only average high school final grades, but working experience in medical professions.

METHODS

With a cross-sectional study, we compare the performance of undergraduate medical students with working experience in adjacent health-care professions (and below-average school leaving-grades) with students who entered medical school directly based on their excellent school records in an Objective Structured Clinical Examination (OSCE). For a sample of more than 1,200 students, we use information on OSCE scores in medical and practical skills, doctor-patient communication/interaction, performance in MC-exams, and core sociodemographic variables.

RESULTS

Waiting list students outperformed their classmates in the demonstration of practical skills. Students admitted via their excellent school grades scored best overall. This difference vanishes once we control for school-leaving grade and age, the two main factors separating the analysed groups. Students from the waiting list have a significantly smaller overall chance to reach excellent grades in the first two years of study.

CONCLUSIONS

Students who gathered experiences in health-care professions before enrolling at medical school can benefit from an expanded role of practical elements in medical studies. Student selection instruments should take these different starting positions and qualities of applicants into account, for example with a quota for the professionally experienced.

Adaptations in clinical examinations of medical students in response to the COVID-19 pandemic: a systematic review

INTRODUCTION

Clinical examinations (assessments) are integral to ensuring that medical students can treat patients safely and effectively. The COVID-19 pandemic disrupted traditional formats of clinical examinations. This prompted Medical Schools to adapt their approaches to conducting these examinations to make them suitable for delivery in the pandemic. This systematic review aims to identify the approaches that Medical Schools, internationally, adopted in adapting their clinical examinations of medical students in response to the COVID-19 pandemic.

METHODS

Three databases and four key medical education journals were systematically searched up to 22 October 2021; a grey literature search was also undertaken. Two reviewers independently screened at title, abstract stage and full text stage against predefined eligibility criteria. Discrepancies were resolved by discussion and involvement of senior authors. Risk of bias assessment was performed using an adapted version of a pre-existing risk of bias assessment tool for medical education developments. Results were summarised in a narrative synthesis.

RESULTS

A total of 36 studies were included, which documented the approaches of 48 Medical Schools in 17 countries. Approaches were categorised into in-person clinical examinations (22 studies) or online clinical examinations (14 studies). Authors of studies reporting in-person clinical examinations described deploying enhanced infection control measures along with modified patient participation. Authors of studies reporting online clinical examinations described using online software to create online examination circuits. All authors reported that adapted examinations were feasible, scores were comparable to previous years' student cohorts, and participant feedback was positive. Risk of bias assessment highlighted heterogeneity in reporting of the clinical examinations.

CONCLUSIONS

This review identified two broad approaches to adapting clinical examinations in the pandemic: in-person and online. Authors reported it was feasible to conduct clinical examinations in the pandemic where medical educators are given sufficient time and resources to carefully plan and introduce suitable adaptations. However, the risk of bias assessment identified few studies with high reporting quality, which highlights the need for a common framework for reporting of medical education developments to enhance reproducibility across wider contexts. Our review provides medical educators with the opportunity to reflect on past practises and facilitate the design and planning of future examinations.

Misjudgment of Skills in Clinical Examination Increases in Medical Students Due to a Shift to Exclusively Online Studies during the COVID-19 Pandemic

In medical school, practical capacity building is a central goal. During the COVID-19 pandemic, a shift to online teaching methods in university was mandated in many countries to reduce risk of SARS-CoV-2 transmission. This severely affected the teaching of psychomotor ability skills such as head and neck examination skills, resulting in a share of students that have only been taught such ENT-specific examination skills with online courses; our study aimed to measure performance and capacity of self-evaluation in these students. After completing a new extensive online Ear Nose Throat (ENT) examination course, we conducted a standardized clinical skills exam for nine different ENT examination items with 31 students. Using Likert scales, self-evaluation was based on questionnaires right before the clinical skills exam and objective evaluation during the exam was assessed following a standardized regime. Self-evaluation and objective evaluation were correlated. To compare the exclusive online teaching to traditional hands-on training, a historic cohort with 91 students was used. Objective examination performance after in-classroom or online teaching varied for single examination items while overall assessment remained comparable. Overall, self-evaluation did not differ significantly after online-only and in-classroom ENT skill teaching. Nevertheless, misjudgment of one’s skill level increased after online-only training compared to in-classroom teaching. Highest levels of overestimation were observed after online training in simple tasks. While gender and interest in ENT did not influence self-evaluation and misjudgment, higher age of participants was associated with an overestimation of skills. Medical students with online-only training during the COVID-19 pandemic achieved similar ENT examination skills to those with traditional on-campus training before the pandemic. Nevertheless, students with online-only training were more prone to misjudge their skills when they assessed their skills. Due to the COVID-19 pandemic, current medical students and graduates might therefore lack individual specific psychomotor skills such as the ENT examination, underlining the importance of presence-based teaching.

A scoping review on adaptations of clinical education for medical students during COVID-19

Rapid advances in clinical education in response to the COVID-19 pandemic are taking place globally. This scoping review updated the educational strategies which could be applied by clinical educators in their practice to effectively maintain clinical attachment programs for medical students amidst public health crises. Almost all elements of clinical teaching were deliverable, whether it was online, onsite, virtual or blended, their educational effectiveness should be further examined. Increase in the number of telemedicine related publications were remarkable, and they could serve as a scalable model for future educational programs to be incorporated into the medical student curricula.