Clinical Skills Scores Research Articles

Voluntary attendance of small-group brainstorming tutoring courses intensify new clerk\u2019s \u201cexcellence in clinical care\u201d: a pilot study

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.

Application of navigation assisted neurosurgery operation system in clinical practice teaching of clinical medicine specialty

Objective To explore the effect of navigation assisted surgery system in the medical teaching in the department of neurosurgery. Method From May 4 of 2015 to June 3 of 2015, 51 medical undergraduates of clinical medicine in the Second Affiliated Hospital of Xi'an Jiaotong University were ran-domly divided into experiment group (navigation assisted surgical technique system teaching, n=25) and traditional group (traditional teaching, n=26). Practical effect of the different modes was evaluated by question-naire and examination results. Data were analyzed by SPSS 20.0. Enumeration data were compared between groups using chi square test or t test. Result After the teaching, the theoretical results of the experimental group and the control group were (83.05 ± 6.03) and (74.32 ± 7.12), and the difference was statistically significant (t=4.96, P=0.005). Clinical skills scores were (89.43 ± 5.12) and (81.11 ± 8.02), and the difference was statistically significant (t=2.91, P=0.029). The questionnaire showed that the experimental group students' satisfaction degree to their own teaching method was better than that of control group (P<0.05). Conclusion Compared with the traditional teaching, the navigation assisted neurosurgical operation has obvious advantages. It can improve students' enthusiasm for learning the professional knowledge and skills in neurosurgery, stimulate students' learning interest and improve students' test scores. Key words: Navigation assisted surgery; Department of neurosurgery; Clinical practice

Effect of progressive problem-based learning in teaching of neurology

Objective To evaluate the effect of progressive problem-based learning(PBL)in teaching of neurology and study its impact factors. Methods A total of 110 5-year undergraduate students were randomly divided into LBL and progressive PBL groups, with 55 students in each group. Both groups accepted basic knowledge, clinical skills, case analysis and document retrieval teaching. Progressive PBL were given by three steps including introduction phase, transition phase and PBL stage. At the end of the internship, theoretical knowledg, practical skill scores and questionnaires were used to evaluate the effects of different teaching methods. Pearson χ2 test was used to analyze the effects of gender, urban-rural character, mastery of relevant based knowledge and intra-group contribution on examination results of progressive PBL. Results Theoretical knowledge score of progressive PBL group was significantly lower than LBL group[(78.49±3.15)vs.(81.94±5.37), t=-4.11, P=0.000], while clinical skill score[(86.34±9.16)vs.(80.96±7.85), t=1.63, P=0.003]and clinical analysis score[(82.25±5.17)vs.(70.54±3.85), t=13.47, P=0.000]of progressive PBL group were significantly higher than LBL group. Teaching satisfaction scales of learning interest(χ2=7.21, P=0.007), self-learning ability(χ2 =6.70, P=0.010), knowledge use ability(χ2 =7.92, P=0.005), analytical thinking ability(χ2=4.36, P=0.037)and expression ability(χ2=9.17, P=0.003)in progressive PBL group were significantly higher than LBL group. Gender(χ2 =0.0109, P=0.917)and urban-rural character(χ2= 0.045, P=0.831)showed no significant impact on examination results of progressive PBL. While relevant based knowledge(χ2=6.82, P=0.009)and intra-group contribution(χ2=4.91, P=0.027)showed significant impact on examination results of progressive PBL. Conclusion Progressive PBL can improve the clinical skill and case analysis ability of students. Relevant based knowledge and intra-group contribution have significant impact on the effect of progressive PBL. Key words: Progressive PBL; Neurology; Impact factor

Regional scale-up of an Emergency Triage Assessment and Treatment (ETAT) training programme from a referral hospital to primary care health centres in Guatemala

ObjectiveEmergency Triage Assessment and Treatment (ETAT) was developed by the WHO to teach paediatric assessment, triage and initial management to healthcare workers (HCWs) in resource-limited hospital-based settings. This study sought...

Using standardized patients in training of assistant general practitioners

Thirty assistant general practitioners (GPs) of Jiading District Shanghai were trained for clinical skills and communication skills by using standardized patients (SP) in outpatient department from January to April 2014. The scores of clinical skills and communication skills were evaluated and compared before and two months after training.The results showed that the score of clinical skills [(72±5) vs (56±7), t=7.871, P 0.05). After training, the scores and the proportions of the trainees qualified for building physician-patient relationship [(20±3) vs (15±4), t=4.056], collecting information and providing feedback [(22±4) vs (13±3), t=4.682], understanding complaints from patients' perspective [(5±2) vs (3±2), t=3.107], sharing information and obtaining informed consent [(19±4) vs (11±5), t=4.322] and closing consultation [(6±2) vs (3±1), t=2.987] were higher than before training (all P<0.05). The results indicate that training by using SP can effectively improve the clinical skills and communication skills of assistant GPs. Key words: Standardized patients; Clinical medical capacity; General practitioners

Evaluation of Clinical and Communication Skills of Pharmacy Students and Pharmacists with an Objective Structured Clinical Examination

Objective. To evaluate how effectively pharmacy students and practicing pharmacists communicate and apply knowledge to simulations of commonly encountered patient scenarios using an objective structured clinical examination (OSCE). Design. Second-, third-, and fourth-year pharmacy students completed an OSCE as part of their required courses in 2012 and 2013. All students in both years completed identical OSCE cases. Licensed pharmacists were recruited to complete the OSCE and serve as controls in 2012. A survey assessed student perception and acceptance of the OSCE as well as student confidence in performance. Assessment. Licensed pharmacists had significantly higher clinical and communication skills scores than did pharmacy students. Student progression in communication and clinical skills improved significantly over time. Survey results indicated that students felt the OSCE was well-structured and assessed clinical skills taught in pharmacy school; 86% of students felt confident they could provide these skills. Conclusion. Objective structured clinical examinations can evaluate clinical competence and communication skills among professional students. Implementation of OSCEs may be an effective tool for assessment of the Center for the Advancement of Pharmacy Education domains.

A Pilot Study of Palliative Care Provider Self-competence and Priorities for Education in Kenya.

This study explored palliative care provider self-competence and priorities for future education in an inpatient hospice setting in Kenya. Self-competence scores for clinical skills and patient and family communication skills were hypothesized to differ according to provider type. A descriptive, cross-sectional study design was piloted at Kimbilio Hospice, a 26-bed rural, inpatient facility in Kenya. A quantitative survey instrument entitled, "Self assessment of clinical competency and concerns in end-of-life care," was administered to participants. Survey responses were collected from 5 clinical staff, 11 caregivers, and 8 support staff. Data were analyzed using Kruskal-Wallis test to compare between mean scores. Statistically significant differences were found in 5 self-competence variables: performing a basic pain assessment, use of oral opioid analgesics, assessment and management of nausea/vomiting and constipation, and discussing an end-of-life prognosis with a patient's family member (P < .05). Sixteen participants (66%) selected pediatric palliative care as their top priority for future education. The findings support the hypothesis that palliative care providers have varying levels of self-competence. Improving education to build palliative care competencies in adult and pediatric palliative care in sub-Saharan Africa is recommended.

Evaluation of the validity of medical students' self-assessments of proficiency in clinical simulations

BackgroundThe accuracy of self-assessments has not been well supported in the literature. This study was undertaken to examine the validity of medical students' ratings of their proficiency during encounters with simulated patients and simulation devices. MethodsConfidential self-assessments for 10 skills were collected from 195 students during a formal clinical skills assessment related to 3 cases at the end of a surgery clerkship. The cases required students to gather data from simulated patients and perform procedures such as rectal examinations, nasogastric tube insertions, and suturing on bench simulation models. The patients were trained to assess student performance. ResultsThere were significant differences between student self-assessments and simulated patient scores for general clinical skills as opposed to procedural skills. Students' mean self-assessments in the data gathering and interpersonal skills were 2–6 % points higher than ratings of their proficiency by simulated patients. However, self-assessments on procedures were 5–8 points lower than patient ratings. The median correlation between self-assessments and patient ratings for general clinical skills such as data gathering and interpersonal skills was 0.08 (not significant), whereas the median correlation between student and patient ratings in procedures was 0.22 (P < 0.01). ConclusionsThird-year medical students' self-assessments for specific procedures are more valid than self-assessments of general clinical skills. Students are less confident in their procedural skills compared with general clinical skills. Although self-assessments should not be used as the sole measure of performance in clinical simulations, self-assessments for specific procedures can provide supplemental information on proficiency.

An innovative nonanimal simulation trainer for chest tube insertion in neonates.

Competence in the chest tube insertion procedure is vital for practitioners who take care of critically ill infants. The use of animals for training is discouraged, and there are no realistic simulation models available for the neonatal chest tube insertion procedure. The objective of this study was to assess the effectiveness of teaching the chest tube insertion procedure by using an easily constructed, nonanimal simulation model. An inexpensive infant chest tube insertion model was developed by using simple hardware. A prospective cohort study with pre-posttest intervention design was conducted with pediatric and combined internal medicine-pediatrics residents. Residents completed a questionnaire about their previous experience of chest tube insertion, knowledge, self-evaluation of knowledge, comfort, and skills; pre, post, and a month after an individualized education session and demonstration of the procedure on the model. Clinical skills were assessed by using a 32-point scoring system when residents performed the procedure on the model immediately after training and a month later. All residents had significant improvement in knowledge and self-evaluation of knowledge, comfort, and skills scores after the education session and training on the model and this improvement was retained after 1 month (P < .001). Clinical skills scores decreased slightly 1 month after training (P = .08). Scores were not significantly different between the levels of trainees. An educational intervention using an easily constructed and inexpensive chest tube insertion model is effective in improving knowledge, comfort, and skills in trainees. The model can be used repeatedly to maintain proficiency.

Multi-station evaluation of comprehensive ability of Shanghai community general practitioner trainers

Objective To assess the comprehensive ability of community general practitioner (GP) trainers in Shanghai by multi-station evaluation. Methods Forty one GP trainers from 4 community teaching base in Shanghai were assessed in a half-day multi-station evaluation including comprehensive knowledge, physical examination, auxiliary investigation, clinical skills and teaching knowledge. Results The mean score and pass rate of comprehensive knowledge were highest (80.4±6.8 and 97.6%), and those of teaching knowledge were lowest (44.5±15.1 and 14.6%). The mean score of clinical skills of GP trainers whose duration of community teaching was more than or equal to 5 years was higher than those less than 5 years (72.1±12.3 vs. 54.9±21.5, t=2.974, P=0.007). There was no significant difference in mean score of 5 items between GP trainers with different working seniority and professional titles.The mean score of basic medical theories (F=4.550, P=0.008), X-ray (F=5.438, P=0.003), clinical skills (F=3.503, P=0.025), teaching knowledge (F=12.607, P<0.001), basic teaching theories and methods (F=11.558, P<0.001), regulations and demands of training (F=7.281, P=0.001) were statistical different among 4 community teaching bases. Conclusions The teaching ability of community GP trainers is relatively weak and need relevant special training.Multi-station evaluation can be applied in selection and assessment of GP trainers. Key words: General practitioner; Teacher training; Educational measurement

Application of four-in-one teaching mode in clinical probation teaching in the department of obstetrics and gynecology

Objective To compare the effect of four-in-one teaching method and traditional teaching method in clinical clerkship teaching in the department of obstetrics and gynecology. Methods Totally 70 clinical probationer were enrolled （ 35 from 2007 grade were taken as control group and 35 from 2008 grade were taken as experiment group ）. Four-in-one teaching method and traditional teaching method were respectively in experiment group and control group. Examination score and clinical skill re- suits were analyzed by t test and satisfaction degree was analyzed byx2 test. P〈O.05 signifies statistical sig- nificances. Results Examination score of experiment group and control group were 86.9 ＋ 7.7 and 76.5 ~ 8.7 respectively with statistically significant differences （ P=0.000 ）. Clinical skill score of experi- ment group and control group were 87.6 ＋ 6.9 and 75.9 ~- 7.5 respectively with statistically significant dif- ferences （/9=-0.000 ）. Each questionnaire index was significantly higher in experiment group than in con- trol group with statistically significant differences （ P=0.O00 ）. Conclusions Four- in-one teaching method can make students understand theoretical knowledge and master obstetrics and gynecology basic clinical skills, enhance interests in learning, build up self-confidence and establish preliminary clinical thinking ability and innovation ability which will lay a solid foundation for future clinical and research practice. Key words: Four-in - one teaching; Traditional teaching ; Clinical probation

Assessing Interpersonal Communications Skills: The Use of Standardized Patients in Graduate Medical Education

Recently, much attention and increased awareness has been placed on patient-centered care in medicine.1 Within the education milieu, 1 facet of patient-centeredness is examining the communication and interpersonal skills competence of resident physicians. Interpersonal communication is 1 of the most difficult competencies in which to ensure proficiency. Many instances of patient-trainee interactions occur without the direct supervision of an attending physician. Thus, these skills are less often assessed through direct attending physician observation.Often the assessment of communication and interpersonal skills relies upon residents' United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills scores obtained during medical school, which leaves a gap in adequately assessing residents' competency and comfort in using communication skills early in their practice.Extensive practice of skills is necessary to learn new skills and maintain existing competencies.2 Most communication skills courses occur at the beginning of medical school3 and often culminate with the USMLE Step 2 Clinical Skills—a performance-based MD (doctor of medicine) licensure certification assessing communication skills. After this examination, attention may shift toward Step 3 and board certifications, both of which lack an observed performance component.The use of standardized patients (SPs) is 1 way to develop and assess competency in interpersonal communication and facilitate patient-centered care. Objective Structured Clinical Examinations have also been demonstrated to be an effective tool to assess content and communication skills, knowledge, patient satisfaction, and professionalism in residency programs.4 The cost of SP programs range from $50 to $500 per resident depending on the type of exercise and the feedback provided.5–8 The cost of developing a program de novo is likely cost-prohibitive to most residency programs—in which case it might be best to focus on training faculty or staff to portray a case.Integrating SP exercises into a residency program's curriculum has the potential to fulfill requirements in the areas of patient care, interpersonal and communication skills, and formative evaluation.9 Program directors are required to “provide each resident with documented semiannual evaluation of performance with feedback.”10 This evaluation may prove beneficial with additional multimedia modalities. Some programs require digital recordings of resident-patient encounters or direct faculty observation for assessment of each resident's competency in interpersonal skills.11 A digitally recorded encounter can be used as a springboard for an individual learning plan or remediation program, or to provide documentation and evidence of a mastered skill. Standardized patient scenarios can be developed to supplement actual patient scenarios by having a resident demonstrate, role-play, or practice a skill not yet demonstrated during clinic or hospital experiences, such as treating patients from various socioeconomic and cultural backgrounds or breaking bad news. Finally, SP encounters, both summative and formative, can provide a rich resource for resident assessment and program evaluation. They can be structured to use multiple evaluators (eg, faculty, peers, patients, and other professional staff) as well.

The Relationship Between Communication Scores From the USMLE Step 2 Clinical Skills Examination and Communication Ratings for First-Year Internal Medicine Residents

This study extends available evidence about the relationship between scores on the Step 2 Clinical Skills (CS) component of the United States Medical Licensing Examination and subsequent performance in residency. It focuses on the relationship between Step 2 CS communication and interpersonal skills scores and communication skills ratings that residency directors assign to residents in their first postgraduate year of internal medicine training. It represents the first large-scale evaluation of the extent to which Step 2 CS communication and interpersonal skills scores can be extrapolated to examinee performance in supervised practice. Hierarchical linear modeling techniques were used to examine the relationships among examinee characteristics, residency program characteristics, and residency-director-provided ratings. The sample comprised 6,306 examinees from 238 internal medicine residency programs who completed Step 2 CS for the first time in 2005 and received ratings during their first year of internal medicine residency training. Although the relationship is modest, Step 2 CS communication and interpersonal skills scores predict communication skills ratings for first-year internal medicine residents after accounting for other factors. The results of this study make a reasonable case that Step 2 CS communication and interpersonal skills scores provide useful information for predicting the level of communication skill that examinees will display in their first year of internal medicine residency training. This finding demonstrates some level of extrapolation from the testing context to behavior in supervised practice, thus providing validity-related evidence for using Step 2 CS communication and interpersonal skills scores in high-stakes decisions.

Correlation Between Student Performances on Course Level Integrated Clinical Skills Examinations and Objective Structured Clinical Examinations in a Chiropractic College Program

This retrospective study measured correlation of student performance between 2 objective structured clinical examinations (OSCEs) and an introductory integrated clinical skills course that preceded the OSCEs. The hypothesis was that there would be a strong, positive correlation between the earlier level examinations and the upper level OSCE, high enough that earlier examinations could be viewed as predictors of upper level OSCE performance. Using student scores for 5 academic terms of upper level OSCEs for 2008-2009 (n = 208) and respective earlier scores, correlation coefficients were calculated for the upper level OSCE and Clinical Skills course, and upper and lower level OSCEs. Multiple linear regression analysis was used to evaluate how well the lower level OSCE and clinical skills scores, both as lone and combined independent variables, predicted the upper level OSCE scores. There was at least a moderate correlation between both sets of scores: r = .51 (p < .001) between upper level OSCE and clinical skills course, r = .54 (p < .001) between the upper and lower level OSCEs. A combination of clinical skills and lower level OSCE scores suggested a moderate prediction of upper level OSCE scores (R(2) = .38.) Correlations were found to be of at least a moderate level. According to linear regression analysis, a combination of the earlier scores was moderately predictive for the upper level OSCE. More research could be done to determine additional components of student performance.

Investigation of intensive care capabilities of nursing interns

Objective To study the status of intensive care capabilities of nursing interns so as to provide guidance for the intensive care specialist nurses training during nursing interns practice stage.Methods Totals of 200 interns who entered the hospital in July 2010 from nursing college were randomly enrolled and investigated with self-designed intensive cating capabilities for nursing interns self-rating scale and analysed their abilities of knowledge,clinical skills and attitudes.Results The total score of intensive care capacity was ( 134.80 ±28.06),knowledge score was (51.08 ± 14.94),clinical skills score was (73.02 ± 15.77),attitudes score was (10.71 ±3.16).Significantly difference was found in whether practiced in the intensive care unit or not (t =5.202,P ＜ 0.05 ),but no significantly difference was found in gender,whether the only child and how long learning intensive care knowledge at school among nursing interns( t =0.669,1.075,0.569,respectively;P ＞0.05).Conclusions The level of intensive caring capabilities of nursing interns is the lower middle,it can enhance their knowledge and clinical skills through certain training in hospital,which can help students get the quality of intensive care unit nurses and competent to the work. Key words: Students,nursing; Clinical practice; Intensive care; Clinical competence

The surgical clerkship: a contemporary paradigm

BackgroundTraditional surgical clerkships have been composed of hospitalized patients, usually in academic centers, daily resident interaction, periodic attending rounds, assigned texts, and a lecture format. However, traditional clerkships do not reflect the current changes in learning theory nor the economic realities of today’s surgical practice. Initiated in 2001, the allopathic Florida State University College of Medicine provided an opportunity to create a contemporary surgical clerkship. MethodsAt each of 6 regional campuses, clerkship students served as apprentices to a board-certified community surgeon. In addition, during weekly meetings with the student, a campus-specific Clerkship Director administered a centralized curriculum with defined objectives and competencies. Contact with residents was minimal, and lectures were not used. Students were free to choose from suggested texts or to use alternative learning sources. An electronic data system monitored patient contacts. Evaluations of the students’ clinical performance are 360 degrees. ResultsTo date, 450 students have graduated. No significant differences were found between campuses for the following: types of patients encountered, U.S. Medical Liscensure Examination Step 2 Clinical Knowledge and Clinical Skills scores, internal Objective Structured Clinical Examination results, or National Board of Medical Examiners scores (P > 0.05). The national examination metrics have been met or exceeded. On the recent anonymous Association of American Medical Colleges Graduation Questionnaire survey, the students rated the surgery clerkship as the best course in the school. Overall, 23.3% of graduates have chosen some aspect of surgery as a career. ConclusionsA quality clerkship in surgery can be provided using a nontraditional community-based system, with as many as 6 distributed campuses. Also, the distributed campus model does not lead to inequality in learning opportunities, surgical experiences, or basic surgical knowledge. Third, documentation of campus comparability is markedly assisted by electronic monitoring. Fourth, the tutorial model offers, at the very least, a comparable learning experience and is strongly supported by both students and the community surgical faculty. Finally, student learning and acquisition of a fund of surgical knowledge in this system has been confirmed by national metrics.

Relationship between the Content of the Medical Knowledge Written Examination and Clinical Skill Score in Medical Students.

This study was planned to investigate which medical knowledge examination score-written examination on basic medicine, individual clinical medicine, and comprehensive clinical medicine-was closely related to clinical skill score in medical students. Scores on basic medicine, clinical medicine, graduation assessment, clinical performance examination (CPX), and objective structured clinical examination (OSCE) for 106 students who graduated Dongguk University Medical School from 2010 to 2011 were included, and correlations between them were analyzed using T scores. All scores of basic medicine, clinical medicine, graduation assessment, CPX, and OSCE correlated significantly with each other. In connection with clinical skill, graduation assessment score showed a strong correlation (r=0.547, p<0.001) with the CPX. Regarding detailed scores on the CPX, history taking score correlated significantly with medical knowledge examination scores (r=0.435~0.406, p<0.001). By regression analysis, the score on graduation assessment was 1 point higher, and that of the CPX increased by 0.538 (p<0.001). Based on our study, comprehensive clinical knowledge is required for medical students to gain the appropriate clinical skills. Therefore, clinical skill practice and lectures that are based on the level of comprehensive clinical knowledge are recommended in the education of clinical skills in medical students.

Evaluating Construct Equivalence and Criterion-Related Validity for Repeat Examinees on a Standardized Patient Examination

Prior studies report large score gains for examinees who fail and later repeat standardized patient (SP) assessments. Although research indicates that score gains on SP exams cannot be attributed to memorizing previous cases, no studies have investigated the empirical validity of scores for repeat examinees. This report compares single-take and repeat examinees in terms of both internal (construct) validity and external (criterion-related) validity. Data consisted of test scores for examinees who took the United States Medical Licensing Examination Step 2 Clinical Skills (CS) exam between July 16, 2007, and September 12, 2009. The sample included 12,090 examinees who completed Step 2 CS on one occasion and another 4,030 examinees who completed the exam on two occasions. The internal measures included four separately scored performance domains of the Step 2 CS examination, whereas the external measures consisted of scores on three written assessments of medical knowledge (Step 1, Step 2 clinical knowledge, and Step 3). The authors subjected the four Step 2 CS domains to confirmatory factor analysis and evaluated correlations between Step 2 CS scores and the three written assessments for single-take and repeat examinees. The factor structure for repeat examinees on their first attempt was markedly different from the factor structure for single-take examinees, but it became more similar to that for single-take examinees by their second attempt. Scores on the second attempt correlated more highly with all three external measures. The findings support the validity of scores for repeat examinees on their second attempt.

The role of multi-media teaching in the ENT physician training

Objective To explore the role of multi-media teaching in the ENT physician training. Methods 32 further-study professionals were randomly divided into 2 groups. The control group received traditional teaching methods(n = 16), and the experimental group received the multi-media teaching method (n = 16). After the training, all trainees would take the theory test and skill assessment Results The basic theory and clinical skill scores of the experimental group are better than the control group at the end of the training. Conclusion Multi-media teaching method is very suitable for ENT refresher training. Key words: Multimedia; ENT; Physicians

Using systematically observed clinical encounters (SOCEs) to assess medical students&amp;rsquo; skills in clinical settings

IntroductionThe Objective Structured Clinical Examination (OSCE) is widely used to assess the clinical performance of medical students. However, concerns related to cost, availability, and validity, have led educators to investigate alternatives to the OSCE. Some alternatives involve assessing students while they provide care to patients – the mini-CEX (mini-Clinical Evaluation Exercise) and the Long Case are examples. We investigated the psychometrics of systematically observed clinical encounters (SOCEs), in which physicians are supplemented by lay trained observers, as a means of assessing the clinical performances of medical students.MethodsDuring the pediatrics clerkship at the University of Iowa, trained lay observers assessed the communication skills of third-year medical students using a communication checklist while the students interviewed and examined pediatric patients. Students then verbally presented their findings to faculty, who assessed students’ clinical skills using a standardized form. The reliability of the combined communication and clinical skills scores was calculated using generalizability theory.ResultsFifty-one medical students completed 199 observed patient encounters. The mean combined clinical and communication skills score (out of a maximum 45 points) was 40.8 (standard deviation 3.3). The calculated reliability of the SOCE scores, using generalizability theory, from 10 observed patient encounters was 0.81. Students reported receiving helpful feedback from faculty after 97% of their observed clinical encounters.ConclusionThe SOCE can reliably assess the clinical performances of third-year medical students on their pediatrics clerkship. The SOCE is an attractive addition to the other methods utilizing real patient encounters for assessing the skills of learners.