Clinical Exam Scores Research Articles

Prediction of general practice licensure/certification examination performance by a measure of 'questionable' activities in clinical practice: a retrospective cohort study.

'Low-value' clinical care and medical services are 'questionable' activities, being more likely to cause harm than good or with disproportionately low benefit relative to cost. This study examined the predictive ability of the QUestionable In Training Clinical Activities Index (QUIT-CAI) for general practice (GP) registrars' (trainees') performance in Australian GP Fellowship examinations (licensure/certification examinations for independent GP). The study was nested in ReCEnT, an ongoing cohort study in which Australian GP registrars document their in-consultation clinical practice. Outcome factors in analyses were individual registrars' scores on the three Fellowship examinations ('AKT', 'KFP', and 'OSCE' examinations) and pass/fail rates during 2012-21. Analyses used univariable and multivariable regression (linear or logistic, as appropriate). The study factor in each analysis was 'QUIT-CAI score percentage'-the percentage of times a registrar performed a QUIT-CAI clinical activity when 'at risk' (i.e. when managing a problem where performing a QUIT-CAI activity was a plausible option). A total of 1265, 1145, and 553 registrars sat Applied Knowledge Test, Key Features Problem, and Objective Structured Clinical Exam examinations, respectively. On multivariable analysis, higher QUIT-CAI score percentages (more questionable activities) were significantly associated with poorer Applied Knowledge Test scores (P = .001), poorer Key Features Problem scores (P = .003), and poorer Objective Structured Clinical Exam scores (P = .005). QUIT-CAI score percentages predicted Royal Australian College of General Practitioner exam failure [odds ratio 1.06 (95% CI 1.00, 1.12) per 1% increase in QUIT-CAI, P = .043]. Performing questionable clinical activities predicted poorer performance in the summative Fellowship examinations, thereby validating these examinations as measures of actual clinical performance (by our measure of clinical performance, which is relevant for a licensure/certification examination).

Effects of rotating at a Catholic hospital on medical student contraceptive objective structured clinical exam scores

ObjectivesTo assess the impact of rotating at a Catholic vs non-religious institution for the inpatient portion of the third-year medical school obstetrics and gynecology clerkship on medical students’ contraceptive competency. Study DesignWe assigned all medical students completing an obstetrics and gynecology clerkship during the 2017–2019 academic years to a Catholic or non-religious hospital for their inpatient teaching site, where they gain much of their contraceptive counseling experience. All students attended the same didactic sessions on contraception. We compared Objective Structured Clinical Exam (OSCE) scores and clerkship grades between the two clinical sites for all medical students. We set significance at p < 0.05. ResultsOf 281 medical students, the 127 (45.2%) who had rotated at a Catholic hospital performed lower on the data-gathering component of the contraceptive OSCE compared with students at the non-religious hospitals (Catholic: 62.4 ± 16.5 vs non-religious: 70.2 ± 15.9, p < 0.01) and had lower total contraceptive OSCE scores (Catholic: 69.4 ± 9.3 vs non-religious: 72.0 ± 8.5, p < 0.01). Clinical reasoning and communication scores for the contraceptive OSCE, data-gathering and total scores for other OSCE scenarios, overall OSCE and clerkship grades were not different. ConclusionRotation at a Catholic hospital, with fewer opportunities for medical students to experience contraceptive counseling, was associated with poorer data-gathering skills for gynecologic and sexual history. While contraceptive knowledge can be imparted didactically, hands-on history-taking and counseling experiences are needed to build competency in contraceptive care. ImplicationsThere is a disparity in medical student family planning training at a Catholic hospital compared with non-religious hospitals. Contraceptive knowledge can be attained through didactic sessions, however additional hands-on practice is needed in gynecologic and sexual history taking if clinical opportunities are limited.

Entrustable Professional Activity-Based Summative Performance Assessment in the Surgery Clerkship

The objectives of this study were to 1) assess the performance Entrustable Professional Activities (EPAs) when integrated into the summative assessment of third-year medical students on the surgery clerkship and 2) to compare EPAs to traditional clinical performance assessment tools. EPA assessments were collected prospectively from a minimum of 4 evaluators at the completion of each surgical clerkship rotation from November 2019 to June 2019. Overall EPA-based clinical performance scores were calculated as the sum of the mean EPA score from each evaluator. A rating of overall clinical performance called the clinical performance appraisal (CPA) was also collected. EPA ratings were compared to the CPA score, National Board of Medical Examiners exam score, objective structured clinical exam scores, and final clerkship grade. Northwestern Memorial Hospital, a tertiary care teaching institution in Chicago, IL. Overall, 446 evaluations (111 students) were included in the analysis. The aggregate EPA scores ranged from 11.6-24.0 (mean 19.9 ± 2.0), and the CPA scores ranged from 4.4-9.0 (mean 7.6 ± 0.7). The variance among learners in EPA scores was significantly higher than CPA scores (p < 0.001). The aggregate EPA scores correlated well with CPA scores (Spearman's rho 0.803) but had lesser, positive correlations with the objective structured clinical exam (rho 0.153) and National Board of Medical Examiners (rho 0.265) scores. When all EPA scores were included in ordinal logistic regression, only EPA 6, oral presentation of patients, was independently associated with students' final grades (OR: 10.05, 95%CI 1.41-71.80; p = 0.02). Integration of EPAs for use in clinical performance assessment of medical students is feasible within a surgery clerkship. Compared to a global clinical performance assessment, EPA-based assessment provided better discrimination of clinical performance among learners. Use of EPAs may better identify advanced learners and those that need additional time.

Analysis of a Near Peer Tutoring Program to Improve Medical Students’ Note Writing Skills

Problem: The ability to document a patient encounter is integral for any physician. Previous studies indicate that medical students’ note writing skills are poor due to a lack of formal clinical documentation instruction. Barriers to formally teaching students how to write patient notes include the significant time burden and variability in faculty feedback. Implementing a near-peer teaching program to teach students how to write a patient note can overcome these barriers and fill this curricular gap. Intervention: Fourth year medical students who completed a Teaching in Medicine elective course were trained to provide individual feedback to 1st and 2nd year students on note writing as a part of their Introduction to Clinical Medicine course. In order to determine the effect of this two year, near-peer feedback program on note writing skills, we analyzed students’ scores on the note writing portion of two Objective Structured Clinical Exams that took place at the end of the 2nd and 3rd years of medical school. Context: The near-peer feedback sessions were implemented in the Fall of 2013 during the preclinical years of the medical school curriculum. Data from students who received near-peer feedback (N = 112) were compared to a historical control group who did not receive near-peer feedback on their note writing (N = 110). Objective Structured Clinical Exam scores that were specific to note writing skills, including the history, physical exam, and differential diagnosis subscales were examined. Impact: The near-peer feedback had a positive impact on the quality of patient notes. On the end of the 2nd year Objective Structured Clinical Exam, the near-peer feedback intervention group outperformed the no feedback group on the history and physical exam subscale scores but not on the differential diagnosis subscale score. One year later, the near-peer feedback intervention group continued to outperform the no feedback group on the physical exam subscale score, but not the history or the differential diagnosis subscale scores. Lessons Learned: Near-peer teaching improves student documentation of the history and physical exam, however only the effects on the physical exam portion persist into the clinical years of training. Writing up a differential diagnosis is a skill that develops through the clerkship experience regardless of exposure to feedback in the preclinical years. Implementing near-peer teaching in the medical school setting is feasible and can provide students with valuable learning experiences without relying on clinical faculty.

Medical students' logbook case loads do not predict final exam scores in surgery clerkship.

PurposeTo investigate the reliability of medical student logbook data in assessing student performance and predicting outcomes in an objective standardized clinical exam and a multiplechoice exam during surgery rotation. In addition, we examined the relationship between exam performance and the number of clinical tutors per student.Materials and methodsA retrospective review of the logbooks of first and third clinical year medical students at the Faculty of Medicine, Kuwait University, was undertaken during their surgery rotation during the academic year 2012–2013.ResultsLogbooks of 184 students were reviewed and analyzed. There were 92 and 93 students in the first and third clinical years, respectively. We did not identify any correlation between the number of clinical encounters and clinical exam or multiple-choice exam scores; however, there was an inverse relationship between the number of clinical tutors encountered during a rotation and clinical exam scores.ConclusionOverall, there was no correlation between the volume of self-reported clinical encounters and exam scores. Furthermore, an inverse correlation between the number of clinical tutors encountered and clinical exam scores was detected. These findings indicate a need for reevaluation of the way logbook data are entered and used as an assessment tool.

Assessment of a Novel Point-of-Care Ultrasound Curriculum's Effect on Competency Measures in Family Medicine Graduate Medical Education.

Point-of-care ultrasound has been shown to decrease the use of expensive diagnostic studies and improve quality outcome measures. Currently, there is a large desire for training in family medicine residencies, but very few programs have established curricula. We sought to develop a family medicine residency curriculum and evaluate it with tools we developed. We wanted our curriculum to be easy to adopt by other residency programs, even if they did not have many well-trained ultrasound faculty. We developed a curriculum in the form of a 4-week rotation in a family medicine residency program. It consisted of self-study videos, hands-on training, and image review. We followed residents in postgraduate years 1 to 3 over a 12-month period. We developed tools, including a knowledge exam, to test image interpretation and clinical decision making, an observed structured clinical exam to assess scanning skills, and a survey to assess perceptions of point-of-care ultrasound in family medicine. The assessments were administered before and after each resident's rotation. Seventeen residents completed the rotation. The average knowledge test score improved significantly, from 62 to 84%. The average observed structured clinical exam scores also improved significantly, from 41 to 85%. The average perception survey scores improved slightly from 4.4 to 4.6. We developed a point-of-care ultrasound curriculum for family medicine residency programs that improves measures of resident attitude, skills, and knowledge. This curriculum can be adopted by residency programs with few faculty members who are experienced in ultrasound.

Optimizing Otoscopy Competency in Audiology Students through Supplementary Otoscopy Training

Scope of practice in audiology encompasses proficiency in visual inspection of ear canal and tympanic membrane (TM) as well as otoscopy interpretation skills to determine normal versus abnormal conditions of outer and middle ear. Audiology students can develop skills in otoscopy through education and supervised training. Studies have shown that additional otoscopy training increased skills in medical students and general practitioners. However, educational and supervised practices targeting otoscopy competency during audiology graduate coursework are lacking. Also, no studies have attempted to determine otoscopy skills among audiology students. To determine the effectiveness of the otoscopy training model on clinical competency and confidence level of audiology students in performing and interpreting otoscopy. A combination of experimental treatment design with random assignment of treatment and control groups and delayed treatment for control group. Thirty-two first- and second-year audiology graduate students who were enrolled in a pediatric audiology class participated in this study. Students were randomly assigned to the control (n = 16, 14 females) or experimental (n = 16, 14 females) group. Participants in the experimental group received supplementary otoscopy training including didactic otoscopy lectures as well as clinical training using manikin ears. The control group received the same pretest and posttest and then completed a third assessment (posttest 2) after receiving the same training. An evaluation of knowledge and skills regarding otoscopy between groups and time was conducted at three times: (a) pretraining, (b) upon completion of training for the experimental group, (c) upon completion of training by the control group. The evaluation consisted of a written exam, a clinical exam, and a self-perception rating of confidence. Both written exam scores and clinical exam scores (otoscopy manikin) were analyzed via two-way analyses of variance (ANOVAs), whereas chi-square (χ²) statistic was conducted to evaluate the effects of training on the confidence level of students of both groups. Experimental and control groups demonstrated significant increased overall competency in otoscopy following the otoscopy training model with didactic and laboratory components. Posttest confidence ratings showed increases in all groups, and there were no significant differences between groups. The need for supplementary otoscopy training was warranted by low knowledge and clinical competency in otoscopy skills of audiology students as measured by pretest mean scores. After completing the training, both experimental and control groups showed significant improvement in knowledge and competency. Results also suggest that perceived confidence ratings may be misleading in determining students' clinical otoscopy skills.

Assessment of masticatory performance, bite force, orthodontic treatment need and orofacial dysfunction in children and adolescents

ObjectivesFew studies have evaluated the relationship between morphological and functional characteristics of the masticatory apparatus in young subjects. Thus, the aim of this study was to evaluate masticatory performance (MP), maximal bite force (BF), orthodontic treatment need and orofacial dysfunction in children and adolescents. DesignThe sample consisted of 316 subjects of both genders, with an age range 6–16years divided into 4 groups: early mixed, intermediate mixed, late mixed and permanent dentition. MP was evaluated by the individual's ability to comminute a chewable test material in order to determine median particle size (X50) and distribution of particles in different sieves (“b”). BF was determined using a digital gnatodynamometer with fork strength of 10mm. Orofacial function and orthodontic treatment need were screened using the Nordic Orofacial Test-Screening (NOT-S) protocol and Index of Orthodontic Treatment Need (IOTN), respectively. The results were submitted to descriptive statistics, normality test, analysis of variance and stepwise multiple linear regression to test relationship between MP and studied independent variables. ResultsVariance of X50 and b between groups was statistically significant. But evaluation of variables that significantly contributed to MP variation showed that age, body mass index (BMI), BF and the presence of sleep bruxism were negatively related to X50 and the NOT-S clinical exam scores showed a positive relationship with X50. ConclusionIn the studied sample, age, BMI, BF and the presence of sleep bruxism were related to better MP; but the increase in NOT-S scores was significantly related to poorer MP.

Effect of portfolio assessment on student learning in prenatal training for midwives

The tendency to use portfolios for evaluation has been developed with the aim of optimizing the culture of assessment. The present study was carried out to determine the effect of using portfolios as an evaluation method on midwifery students' learning and satisfaction in prenatal practical training. In this prospective cohort study, all midwifery students in semester four (n=40), were randomly allocated to portfolio and routine evaluation groups. Based on their educational goals, the portfolio groups prepared packages which consisted of a complete report of the history, physical examinations, and methods of patient management (as evaluated by a checklist) for women who visited a prenatal clinic. During the last day of their course, a posttest, clinical exam, and student satisfaction form were completed. The two groups' mean age, mean pretest scores, and their prerequisite course that they should have taken in the previous semester were similar. The mean difference in the pre and post test scores for the two groups' knowledge and comprehension levels did not differ significantly (P>0.05). The average scores on questions in Bloom's taxonomy 2 and 3 of the portfolio group were significantly greater than those of the routine evaluation group (P=0.002, P=0.03, respectively). The mean of the two groups' clinical exam scores was significantly different. The portfolio group's mean scores on generating diagnostic and therapeutic solutions and the ability to apply theory in practice were higher than those of the routine group. Overall, students' satisfaction scores in the two evaluation methods were relatively similar. Portfolio evaluation provides the opportunity for more learning by increasing the student's participation in the learning process and helping them to apply theory in practice.