Abstract
BackgroundClerkship provides a unique way of transferring the knowledge and skills gathered during medical school’s curriculum into real-ward clinical care environment. The annual program evaluation has indicated that the training of clerks in diagnostic and clinical reasoning skills needed to be enhanced. Recently, “clinical excellence” program have been promoted in our institution to augment the excellence in clinical care of new clerks. Current study aims to evaluate whether this pilot program improve the “clinical excellence” of new clerks.MethodsIn a pilot study, groups of new clerks in years 2013 and 2014 voluntarily attended either a small-group brainstorming course or a didactic classroom tutoring courses as part of their 3-month internal medicine clinical rotation block. A third group of new clerks did not join either of the above courses and this group served as the control group. Pre-block/post-block self-assessment and post-block 5-station mini-Objective Subjective Clinical Examinations (OSCEs) were used to evaluate the effectiveness of these two additional courses that trained diagnostic and clinical reasoning skills.ResultsOvertime, the percentages of new clerks that attended voluntarily either the small-group brainstorming or classroom tutoring courses were increased. Higher post-block self-assessed diagnostic and clinical reasoning skill scores were found among individuals who attended the small-group brainstorming courses compared to either the didactic group or the control group. In a corresponding manner, the small-group brainstorming group obtained higher summary OSCEdiag and OSCEreason scores than either the didactic group or control group. For all basic images/laboratory OSCE stations, the individual diagnostic skill (OSCEdiag) scores of the small-group brainstorming group were higher than those of the didactic group. By way of contrast, only the clinical reasoning skill (OSCEreason) scores of the basic electrocardiogram and complete blood count + biochemistry OSCE station of thesmall-group brainstorming group were higher than those of the didactic group. Among the small-group brainstorming group, clerks with higher cumulative learning hours (>30-h) had significant higher OSCEdiag and OSCEreason scores (>400) than those with less cumulative learning hours.ConclusionOur pilot study provides a successful example of the use of a small-group tutoring courses for augmenting the diagnostic and clinical reasoning skills of new clerks. The positive results obtained during the initial 2-year long pilot “clinical excellence” program have encouraged the formal implementation of this course as part of the clerkship curriculum.
Highlights
Clerkship provides a unique way of transferring the knowledge and skills gathered during medical school’s curriculum into real-ward clinical care environment
Our pilot study provides a successful example of the use of a small-group tutoring courses for augmenting the diagnostic and clinical reasoning skills of new clerks
The mean age and sex (% of male in total) ratios were similar among three groups of clerks [participants of small-group brainstorming tutoring course group (n = 84), the classroom tutoring lecture group (n = 86) and the control group (n = 82) who did not attend either of the above courses]
Summary
Clerkship provides a unique way of transferring the knowledge and skills gathered during medical school’s curriculum into real-ward clinical care environment. It is suggested that the implementation of well-constructed clinical training course, especially diagnostic and clinical reasoning skills, is a highly effective way of preparing clerks for real-ward clinical care [2, 6]. Our clerkship committee leads a “clinical excellence” program that constructed two additional small-group brainstorming course and a classroom didactic course. These two courses are designed to improve the diagnostic and clinical reasoning skills of new clerks. These courses’ contents emphasized the ability to assemble knowledge rather than memorize knowledge
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