Examination In Clinical Practice Research Articles

Effects of Module Development and Role Play Course on Clinical Practice Examination Scores during a 4th Year Clerkship.

BackgroundAfter introduction of clinical skills assessment in the Korean Medical Licensing Examination, medical schools have reinforced both experiential learning with real patients and preparatory programs. This study was conducted to investigate whether a clinical practice examination (CPX) preparation program improves students' CPX score in terms of case specificity.MethodsOne hundred and thirteen senior students in a medical school participated in this study. During the fourth-year clerkship, 28 students (24.8%) from three rotation groups took a 3-day CPX preparation course consisting of module development, role play, and comprehensive physical exam skills training. Eleven rotation groups (n=85) were compared as control. Both the intervention and control group took two comprehensive CPXs before and after the clerkship was completed.ResultsThere was no significant difference in age, sex, and school type between the two groups. On pre-test CPX, there was no significant difference in total and sectional scores between the two groups. On post-test CPX, total scores of the intervention group were higher than those of the control groups (69.5±4.3 vs. 67.5±4.4, P<0.05). History taking scores were higher in intervention groups (70.0±6.0 vs. 66.0±6.6, P=0.01). The station scores of vaginal discharge with case similarity were higher in the intervention groups (73.0±6.3 vs. 68.9±9.3, P=0.03).ConclusionA short CPX preparation course improved history taking ability, but its effect was greater only in a specific case, similar to the pre-course case. Whether this effect was due to the test experience or true improvement in competency requires further investigation.

Comparison of Patient-Physician Interaction Scores of Clinical Practice Examination between Checklists and Rating Scale.

BackgroundThe clinical practice examination (CPX) was introduced in 2010, and the Seoul-Gyeonggi CPX Consortium developed the patient-physician interaction (PPI) assessment tool in 2004. Both institutions use rating scales on classified sections of PPI but differ in their scoring of key components. This study investigated the accuracy of standardized patient scores across rating scales by comparing checklist methods and verified the concurrent validity of two comparable PPI rating tools.MethodsAn educational CPX module dyspepsia case was administered to 116 fourth-year medical students at Hanyang University College of Medicine. One experienced standardized patient rated exams using two different PPI scales. She scored checklists composed of 43 items related to the two original PPI scales through video clips of the same students. From these checklists, we calculated Pearson's correlation coefficient.ResultsThe correlations of total PPI score between the checklist and rating scale methods were 0.29 for the Korean Medical Licensing Examination (KMLE) tool and 0.30 for the consortium tool. The correlations between the KMLE and consortium tools were 0.74 for checklists and 0.83 for rating scales. In terms of section scores, the consortium tool showed only three significant correlations between the two methods out of seven sections and the KMLE tool showed only two statistically significant correlations out of five sections.ConclusionThe rating scale and checklist methods exhibited a weak relationship in the PPI assessment, but a high correlation between assessment tools using the same method. However, the current rating scale requires modification by reorganizing key scoring components through factor analysis.

Utiliy of CPX as a Way to Assess Communication Skill

Purpose: The communication skills of doctors become important as recent changes in health care environment. The clinical practice examination (CPX) has been introduced in many countries as a way to assess communication skill. The purpose of this paper was to determine whether CPX is useful to assess communication skills through an evaluation the correlation between the CPX score and the written multiple-choice question (MCQ) examination on the In-training examination for family medicine. Methods: The subjects of this study were 31 residents in Seoul and Gyunggi-do. CPX consists of 5 station (low back pain, rectal bleeding, blood tinged sputum, bad news delivery, alcoholic) using standardized patient (SP) was performed on April, 2007. We determined the correlation between the total scores and 4 domain scores (history taking, physical examination, patient education, and patient-physician interaction) on the CPX with the MCQ score of the In-training examination for family medicine 2007. Results: The total score of CPX and the CPX scores on history taking, patient education and patient-physician interaction did not correlate with MCQ score of In-training examination for family medicine, The CPX score on physical examination correlated slightly with MCQ score. Conclusion: The lower correlation with other existing examination tool is, the higher the value independently. Our experiences suggest that CPX has specific evaluation region and is useful to assess the communication skills of family physician.

Correlation of CPX Scores with the Scores on Written Multiple-Choice Examinations on the Certifying Examination for Family Medicine in 2009 to 2011.

Recently, the clinical practice examination (CPX) using standardized patients has been introduced into several specialty certifying examinations in Korea. The purpose of this paper was to determine the correlation of a resident's performance on the CPX with the comprehensive written multiple-choice question (MCQ) examination on the certifying examination for family medicine. The subjects of this study were 1,023 residents who completed the 1st and 2nd certifying examination for family medicine between 2009 and 2011. We determined the correlation between the total scores and 4 domain scores (history taking, physical examination, patient education, and patient-physician interaction) on the CPX with the MCQ scores of the 1st written test and 2nd slide examination and the correlation between the total CPX score and scores on the CPX domains. The correlation between CPX score with each MCQ examination (0.21~0.45 with 1st written MCQ, 0.15~0.33 with 2nd slide MCQ) was lower than that between each MCQ examination (0.46~0.59). The CPX score on patient education did not correlate with the 1st written and 2nd MCQ scores. The CPX scores on history taking and physical examination correlated slightly with the 1st written MCQ scores. The global ratings of preceptor examiners had the highest correlation (r=0.68~0.82) with the total CPX scores. Considering the mild correlation of CPX scores with each MCQ examination, the CPX is more likely to measure other qualities, such as critical thinking and communication skills.

Effective use of interpreters by family nurse practitioner students: Is didactic curriculum enough?

Nurse practitioners (NPs) care for patients with limited English proficiency (LEP). However, NP education for improving communication in interpreted encounters is not well reported. We report a single school study using standardized encounters within a clinical practice examination (CPX) to assess the adequacy of current curriculum. Entering family NP (FNP) students (n=26) participated in a baseline CPX case. They were assessed by standardized patients using the validated Interpreter Impact Rating Scale (IIRS) and Physician-Patient Interaction (PPI) scale, and by interpreters using the Interpreter Scale (IS).The case was re-administered to 31 graduating students following completion of existing curriculum. Primary outcome was aggregate change in skills comprising global IIRS, PPI and IS scores. Pre- and post-performance data were available for one class of 10 students. Secondary outcome was change in skill scores for this class. Mean aggregate global scores showed no significant improvement between scores at entry and graduation. For 10 students with pre- and post-performance data, there was no improvement in skill scores for any measure. Skill assessed on one measure worsened. FNP students show no improvement in skills in working with interpreters with the current curriculum. An enhanced curriculum is needed.

Oregon Health &amp; Science University School of Medicine

Number of Activities: 145 Number of Hours of Instruction: 1,964 Number of Physician Participants: 29,136 Number of Other Learners: 17,094 Received Commercial Support: Yes Received Income from Advertising or Exhibits: Yes Participated in Joint Providership: Yes Offered Courses: Yes Offered Enduring Materials: Yes Offered Internet Enduring Materials: Yes Offered Performance Improvement: Yes Offered RSS: Yes Offered Test Item Writing: Yes

Validating Measures of Third Year Medical Students’ Use of Interpreters by Standardized Patients and Faculty Observers

BackgroundIncreasing prevalence of limited English proficiency patient encounters demands effective use of interpreters. Validated measures for this skill are needed.ObjectiveWe describe the process of creating and validating two new measures for rating student skills for interpreter use.SettingEncounters using standardized patients (SPs) and interpreters within a clinical practice examination (CPX) at one medical school.MeasurementsStudents were assessed by SPs using the interpreter impact rating scale (IIRS) and the physician patient interaction (PPI) scale. A subset of 23 encounters was assessed by 4 faculty raters using the faculty observer rating scale (FORS). Internal consistency reliability was assessed by Cronbach’s coefficient alpha (α). Interrater reliability of the FORS was examined by the intraclass correlation coefficient (ICC). The FORS and IIRS were compared and each was correlated with the PPI.ResultsCronbach’s α was 0.90 for the 7-item IIRS and 0.88 for the 11-item FORS. ICC among 4 faculty observers had a mean of 0.61 and median of 0.65 (0.20, 0.86). Skill measured by the IIRS did not significantly correlate with FORS but correlated with the PPI.ConclusionsWe developed two measures with good internal reliability for use by SPs and faculty observers. More research is needed to clarify the reasons for the lack of concordance between these measures and which may be more valid for use as a summative assessment measure.

APPLIED RESEARCH: Effectiveness of Lectures Attended via Interactive Video Conferencing Versus In-Person in Preparing Third-Year Internal Medicine Clerkship Students for Clinical Practice Examinations (CPX)

Background: The current practice in medical education is to place students at off-site locations. The effectiveness of these students attending remote lectures using interactive videoconferencing needs to be evaluated. Purpose: To determine whether lecture content covering clinical objectives is learned by medical students located at remote sites. Methods: During the University of Vermont medicine clerkship, 52 medical students attended lectures both in person and via 2-way videoconferencing over a telemedicine network. The study used a crossover design, such that all students attended half of the lectures in person and half using videoconferencing. At the end of the clerkship, students were assessed via a Clinical Practice Examination (CPX), with each student completing 1 exam for material learned in person and 1 for material learned over telemedicine. Results: Exam scores did not differ for the 2 lecture modes, with a mean score of 76% for lectures attended in person and a mean score of 78% for lectures attended via telemedicine (p = 0.66). Conclusions: Students learn content focused on clinical learning objectives as well using videoconferencing as they do in the traditional classroom setting.

APPLIED RESEARCH: Effectiveness of Lectures Attended via Interactive Video Conferencing Versus In-Person in Preparing Third-Year Internal Medicine Clerkship Students for Clinical Practice Examinations (CPX)

Abstract Background: The current practice in medical education is to place students at off-site locations. The effectiveness of these students attending remote lectures using interactive videoconferencing needs to be evaluated. Purpose: To determine whether lecture content covering clinical objectives is learned by medical students located at remote sites. Methods: During the University of Vermont medicine clerkship, 52 medical students attended lectures both in person and via 2-way videoconferencing over a telemedicine network. The study used a crossover design, such that all students attended half of the lectures in person and half using videoconferencing. At the end of the clerkship, students were assessed via a Clinical Practice Examination (CPX), with each student completing 1 exam for material learned in person and 1 for material learned over telemedicine. Results: Exam scores did not differ for the 2 lecture modes, with a mean score of 76% for lectures attended in person and a mean score of 78% for lectures attended via telemedicine (p = 0.66). Conclusions: Students learn content focused on clinical learning objectives as well using videoconferencing as they do in the traditional classroom setting.

The New Horizon for Evaluations in Medical Education in Korea

Over the last two decades, there have been a number of significant changes in the evaluation system in medical education in Korea. One major improvement in this respect has been the listing of learning objectives at medical schools and the construction of a content outline for the Korean Medical Licensing Examination that can be used as a basis of evaluation. Item analysis has become a routine method for obtaining information that often provides valuable feedback concerning test items after the completion of a written test. The use of item response theory in analyzing test items has been spreading in medical schools as a way to evaluate performance tests and computerized adaptive testing. A series of recent studies have documented an upward trend in the adoption of the objective structured clinical examination (OSCE) and clinical practice examination (CPX) for measuring skill and attitude domains, in addition to tests of the knowledge domain. There has been an obvious increase in regional consortiums involving neighboring medical schools that share the planning and administration of the OSCE and CPX; this includes recruiting and training standardized patients. Such consortiums share common activities, such as case development and program evaluation. A short history and the pivotal roles of four organizations that have brought about significant changes in the examination system are discussed briefly.

University of Arkansas for Medical Sciences College of Medicine

University of Arkansas for Medical Sciences College of Medicine

Incorporating Nutrition in Objective Structured Clinical Examinations for Medical and Residency Education

The use of the standardized patient Objective Structured Clinical Examination (OSCE) and the Clinical Practice Examination (CPX) in predoctoral programs and residencies is on the increase. This type of examination is being tested for its usefulness in licensing examinations. Its important that nutrition be incorporated into these tests if nutrition medical education is to be improved. We will describe the procedure for developing an OSCE case. The example will be a prenatal case developed and tested at a family medicine residency program. The description will include: a) identifying the content for teaching and testing, b) preparing the case scenario including clinical, psychosocial, and presenting information; c) preparing the standardized patient training materials; d) preparing the case summary; e) outlining the patient case; f) training the simulated patient; 5) developing the standardized patient checklist; 6) developing and validating the observer checklist of critical elements; and 7) grading and remediation. We will highlight the nutrition points incorporated into the case. We will show video samples of the students taking the prenatal OSCE, focusing on the nutrition elements. This type of examination is also appropriate for dietetic education, and we will discuss the results obtained during the pilot test with primary care physicians.