Effectiveness of a simulated clinical examination in the assessment of the clinical competencies of entry-level trainees in a family medicine residency programme

Abstract

Clinical competence is a multidimensional concept and encompasses a variety of skills including procedural, problem-solving and clinical judgement. The initial stages of postgraduate medical training are believed to be a particularly important time for the development of clinical skill competencies. This study reports on an evaluation of a Simulated Clinical Examination (SCE) method as a means of assessing the clinical skill competencies of entry-level family medicine residents. Two entering cohorts of PGY1 family medicine residents (N = 35) participated in a SCE encompassing realistic clinical encounters with standardised patients (SPs). Residents were asked to complete pre- and post-evaluation surveys, and both faculty and residents were invited to participate in separate focus groups. The SCE was perceived as a useful method during the early phases of postgraduate training for assessing clinical skill competencies, providing constructive feedback to residents and enhancing self-awareness and confidence. The SCE also appeared to be useful in fostering confidence in interviewing and diagnostic reasoning, however self-reported confidence in the ability to perform clinical skill tasks related to history taking, physical examination and differential diagnosis was not associated with observed performance in these areas. The SCE was an effective technique for benchmarking skill performance, however further research is required to evaluate the effect of this on the self-assessment abilities of trainees over the course of postgraduate medical education.