Clinical Skills Course Research Articles

Student perceptions of iBooks as a clinical skills learning resource as compared to learning management software and an online video-hosting site

Background: Learning resources to support clinical skills training can be delivered through a number of technology platforms, and listening to students’ preferences can be helpful in leveraging the use of technology in the laboratory. Objective: This study sought to compare students’ preference of clinical skills educational resources delivered by iBooks with that by a learning management system (Blackboard) and a video-hosting website (YouTube). Methods: A survey was conducted among veterinary students (n = 73) who completed their first year of clinical skills training. During the fall semester, they utilized 14 free iBooks, one per clinical skills laboratory, to prepare for fall laboratories. In the spring semester, their learning materials were provided on Blackboard and YouTube. At the end of the academic year, they were surveyed about their experiences and preferences. Results: Students reported a preference for the iBooks to the Blackboard and YouTube resources. This preference was the result of the convenience of having all resources on a single, well-organized platform and having access to iBooks after graduation as a perpetual reference, unlike Blackboard resources that students lose access to upon graduation according to the university policy. Students reported technological issues with iBooks, including downloading problems, at a similar rate as technological issues with Blackboard and YouTube. Conclusion: Educators should be guided by students’ preferences, provided the learning outcomes are similar, when selecting platforms for providing student educational resources. Although the iBooks seem preferable, additional research is necessary to understand how students use the iBooks and how that use impacts their clinical skills course performance.

Teaching Clinical Skills Online: Techniques, Student Feedback, and Lesson Learned

The use of online education has long been used in occupational therapy for both post professional and continuing education. In entry level programs, however, strict online education is not common due to the intensive clinical skills that the students must obtain. These are typically taught in lab format with consistent practice and faculty feedback. Due to the COVID 19 epidemic, many universities were forced to make a rapid transition to online learning with little preparatory time. While it is believed that many courses were conducive to this change in format, instructors of clinical skills courses were forced to identify creative and alternative methods of teaching and evaluating the hands-on skills. This paper outlines pedagogy used during the pandemic in teaching clinical skills, both physical and thinking, and students’ responses to the online learning process. Evidence is scarce and does not fully encompass the concept of full clinical skills teaching in an online format. The need for further advancement in this area is highlighted along with potential methods to begin to shape online clinical skills learning.

Teaching Trauma-Informed Care: A Symposium for Medical Students.

A large body of evidence links exposure to childhood trauma with negative health outcomes. Training future physicians to recognize and respond to trauma is paramount, and engaging medical students in the preclinical years affords the opportunity to foster the development of a trauma-informed lens that can then be solidified during clinical clerkships. We developed and implemented a 4-hour trauma-informed care (TIC) symposium for 179 second-year medical students at the George Washington University School of Medicine and Health Sciences during the Patients, Populations, and Systems course. The symposium included three interactive didactic sessions focusing on the connection between trauma and health and TIC principles. A facilitated small-group discussion allowed students to apply TIC principles to a patient case, followed by reflection and evaluation. The overall rating of the TIC symposium was 4 out of 5. Strengths included integration of a small-group case with discussion on application of TIC in practice, experience of the lecturers and small-group facilitators, and review of research relating adversity to specific health outcomes. Suggestions for improvement included incorporating role-play and standardized patients. Content analysis of student reflections mapped to the domains of physician competency. A 4-hour symposium can affect student knowledge and understanding of TIC. Teaching TIC presents an opportunity to prepare medical students for a career in medicine through cultivation of required physician competencies. Next steps include enhanced opportunities to practice TIC and follow-up analysis of participants to determine behavior change during clinical years.

Medical Students' Longitudinal Learning With Older Adults: Geriatrics Education Mentor Program

The University of New England College of Osteopathic Medicine (UNECOM) Geriatrics Education Mentor (GEM) Program is in its sixth year. It's a joint project between older community living adults and 2nd year medical students within the Osteopathic Clinical Skills course. The GEM program goal is to foster understanding and importance of the person/patient-provider relationship. Pairs of osteopathic medical students (N=87 +/- 5) were assigned to an older adult GEM (mentor) volunteer (N=87 +/-5) living within a 50 mile radius of UNECOM. Snowball sampling was used to recruit the GEMs; student participation is required. Four (4) home visits were conducted over 9 months with an assigned GEM; each visit included a new assignment. Students observed, summarized, and recorded experiences communicated by the GEM for each cumulative assignment. Data from assignments were “graded” and content analyses of open ended evaluation/summary questions were conducted. This program is UNE IRB approved. Student pairs completed all assignments. Assignments analysis on Blackboard revealed that students developed respect and awareness of life and medical experiences of the GEM; expressed understanding of the GEM’s life experiences and goals for what “matters most”. Relationships with older adults were established while students maintained professionalism and succeeded in competent and confident interactions. Documentation review from the 4 assignments aided in building students’ geriatrics knowledge, attitudes and skills. Pre-clinical medical education tends to be episodic; providing an opportunity to establish longitudinal assignments over the course of the academic year with the same older adult augments relationship skills and learning in geriatrics.

The relation of online learning analytics, approaches to learning and academic achievement in a clinical skills course.

This study examined relationships of students' access of e-learning (learning analytics) for a healthcare psychomotor skills course, approaches to learning (R-SPQ-2F psychometric) and academic achievement (summative examination results). An understanding of the relationships may help in supporting students learning. Two consecutive cohorts of 5th year dental students were asked to complete the R-SPQ-2F questionnaire and permission to access data of online videos and associated quizzes and two summative written examination results were examined. The summative assessments were an OSCA and a written-paper question both in prosthodontics. Multiple linear regression and correlation analysis were performed. Students (n=98) performed a total of 10470 video access events and 7714 attempts in online quizzes. Deep learning approach was the strongest predictor variable (β=0.270; P=.004) on written-paper question result. While video and quiz access were moderately correlated (r=0.600; P<.001) to each other, video access was not a significant predictor to either of the examination results. Quiz access was negatively associated with academic achievement for the written-paper question results (β=-0.349; P<.001). Only deep approach to learning appeared to be relevant for the written-paper question examination grades. Conversely, the number of video and quiz access did not relate to either examination results. This suggests e-learning access and examinations do not appear to relate under the conditions explored. Other attributes of learning management access may need to be explored to determine if access to learning management systems may be useful in offering remedial support to students.

The Electronic Health Record Objective Structured Clinical Examination Station: Assessing Student Competency in Patient Notes and Patient Interaction.

IntroductionThe ability to utilize the electronic health record (EHR) without compromising the doctor-patient relationship (DPR) is an essential skill of all physicians and trainees, yet little time is spent on educating or assessing learners on needed techniques. To address this gap, we developed a conventional OSCE station coupled with a simulated patient chart within the Epic program in order to assess our students' skills utilizing the EHR during a patient encounter.MethodsOf third-year medical students, 119 were given full access to the patient's simulated chart 24 hours in advance of their OSCE to review clinical data. During an in-person OSCE with a standardized patient (SP), students performed a focused history and physical, using the EHR to verify allergies and medications. Students completed an electronic patient note graded by faculty. SPs evaluated the students on communication and interpersonal skills with specific rubric elements. Faculty graded the students' notes to evaluate their expression of clinical reasoning in the assessment and plan.ResultsTraining SPs and faculty to assess students on EHR skills was feasible. After implementation of a comprehensive curriculum focused on EHR and DPR, there was a significant difference on EHR-related communication skills (M = 76.4, SD = 17.6) versus (M = 37, SD = 28.9) before curriculum enhancement t (117.9) = −12.4, p <.001.DiscussionThe EHR OSCE station provided a standardized method of assessing students' EHR skills during a patient encounter. Challenges still exist in the technological requirements to develop and deliver cases in today's EHR platform.

Recognizing Reflection: Computer-Assisted Analysis of First Year Medical Students' Reflective Writing.

Reflective writing is used throughout medical education to help students navigate their transformation into medical professionals. Assessment of reflective writing, however, is challenging; each available methodology of assessment has distinct advantages and disadvantages. We tested if combining two independent assessment mechanisms-a faculty-designed rubric and Academic Writing Analytics (AWA), an automated technique-could be used together to form a more robust form of evaluation. We obtained reflective essays written by first year medical students as part of a clinical skills course. Faculty scored essays using a rubric designed to evaluate Integration, Depth, and Writing. The same essays were subjected to AWA analysis, which counted the number of reflective phrases indicative of Context, Challenge, or Change. Faculty scored the essays uniformly high, indicating that most students met the standard for reflection as described by the rubric. AWA identified over 1400 instances of reflective behavior within the essays, and there was significant variability in how often different types of reflective phrases were used by individual students. While data from faculty assessment or AWA alone is sufficient to evaluate reflective essays, combining these methods offer a richer and more valuable understanding of the student's reflection.

Using a Hybrid Lecture and Small-Group Standardized Patient Case to Teach the Inclusive Sexual History and Transgender Patient Care.

Previous negative experiences with the medical community often leave transgender people reluctant to seek medical care. Inadequate teaching and exposure to transgender health during medical training perpetuates the health disparities experienced by this community. Although undergraduate medical education is uniquely positioned to address these disparities, curricular coverage of these topics remains inadequate. The second-year clinical skills course at the Florida International University Herbert Wertheim College of Medicine includes a workshop consisting of a 1-hour lecture about the inclusive sexual history, followed by a 1.5-hour small group during which students interview a standardized patient playing the role of a transgender man and participate in a faculty-facilitated debriefing. To evaluate the 2019 workshop, students were provided with an optional, anonymous, pre- and postsession survey consisting of multiple choice and Likert-type questions. After the session, there was a statistically significant increase in students' knowledge of the components of an inclusive sexual history, in the number of students who believed that their medical training had prepared them to effectively provide care for transgender patients, and in the number who reported feeling comfortable taking a sexual history from a patient who identifies as transgender. Most students thought the standardized patient case was realistic and found the postencounter debriefing session helpful in identifying their own strengths and weaknesses. Our findings suggest that students found this brief, interactive sexual history workshop, which included a lecture and standardized patient case, to be an effective component of their medical training. Although our transgender patient case was acted primarily by cis-gender people, students perceived this as a realistic opportunity to actively explore the nuances of obtaining a history from a transgender patient. In addition, our findings suggest that it is possible to merge teaching on sexual history and transgender health care, which is important in time-limited undergraduate medical education curricula.

East Tennessee State University James H. Quillen College of Medicine.

East Tennessee State University James H. Quillen College of Medicine.

Medical University of South Carolina College of Medicine.

Medical University of South Carolina College of Medicine.

Louisiana State University School of Medicine in New Orleans.

Louisiana State University School of Medicine in New Orleans.

Addressing the Rapidly Increasing Need for Telemedicine Education for Future Physicians.

As the COVID-19 pandemic affected the ability to conduct in-person sessions to teach clinical skills, our medical school developed a curriculum to introduce first-year medical students to telemedicine visits, while also reinforcing their history-taking and clinical reasoning skills. All first-year medical students at Florida Atlantic University went through three sessions on telemedicine that began with a lecture, followed by a standardized patient interaction, then a small group meeting with clinical faculty. We assessed the sessions using survey questions on a 5-point Likert scale and additional narrative feedback. We also assessed students on a telemedicine objective structured clinical examination (OSCE) at the end of the semester and compared results to the previous year's same case done in person. Students overall found the sessions helpful for refining their history-taking skills and that the knowledge gained would be helpful in their future practices. They felt the online platform was a useful way to interact with patients, but had frustrations with technical difficulties. They also expressed a greater appreciation for the ability to perform an in-person physical examination. Students performed similarly on the OSCE station in person compared to virtual visits (mean score 93% vs 93.75%). Introducing telemedicine during a first-year medical school clinical skills course provides students with opportunities to refine their clinical skills while introducing a skill that will be commonplace in the postpandemic environment. This curriculum could be adopted not only during a time of necessary distance learning, but also continued as in-person education resumes.

Dell Medical School at the University of Texas, Austin.

Dell Medical School at the University of Texas, Austin.

University of Nevada, Reno School of Medicine

University of Nevada, Reno School of Medicine

Texas Tech University Health Sciences Center School of Medicine, Lubbock.

Texas Tech University Health Sciences Center School of Medicine, Lubbock.

The GI Simulated Clinic: A Clinical Reasoning Exercise Supporting Medical Students' Basic and Clinical Science Integration.

IntroductionCognitive integration is required to perform clinical decision-making tasks, even in the preclinical curriculum of medical school. Simulation supports students' cognitive integration by providing practical application of basic science knowledge in a relevant clinical context. To address the need for integrative activities in our curriculum, we implemented a simulated clinic exercise with cases representing gastrointestinal diseases for first-year medical students.MethodsBasic science and clinical skills course directors collaborated to design this simulated clinic event, during which student small groups rotated through a series of standardized patient encounters. During each encounter, one student performed the history and physical exam, following which the small group collaboratively developed a prioritized differential diagnosis. Afterwards, the gastroenterology course director debriefed students to highlight key learning points. We collected learner evaluation data following the event.ResultsTwo hundred eighty first-year medical students participated in the simulated clinic in 2018 and 2019. Students rated these events as effective for learning about clinical features of the diseases presented and for reinforcing skills learned in the clinical skills course. Students agreed that the small-group format, pace, and duration were appropriate and that the problem-solving aspect was intellectually stimulating. The most effective aspects were opportunities to solidify illness scripts, apply knowledge to solve a problem, and encounter diseases in a realistic clinical context.DiscussionThis simulated clinic model effectively supported preclinical students' basic and clinical science integration to complete diagnostic reasoning tasks for gastrointestinal gastrointestinal conditions and was evaluated favorably by learners.

Effect of adolescent and young adult cancer placements on advanced communication skills.

e24182 Background: Communication with adolescent and young adult cancer (AYA) patients and their families can be challenging and requires extensive skills, often developed over time. Medical students can be afraid to encounter such challenges and treating teams can be protective of these vulnerable patients. Therefore, medical students can have little contact and experience communicating with AYA putting them at a disadvantage. We have developed a special study module (SSM) for students with the AYA multi-disciplinary team to promote student awareness of the unique challenges of communicating with AYA patients and provide essential skills for later practice. We present the findings from the first year of this module. Methods: Students at the University of Cambridge were offered a 6-week placement with the AYA cancer service. This involved shadowing members of the multi-professional cancer team and time on the AYA ward to talk with patients and their families in order to practice triadic communication skills. Mid-placement, an experiential learning experience with simulated patients focused on triadic interviews was also offered in line with our local clinical communication skills courses. After the module students were questioned about how they felt this had affected their practice and knowledge of communicating with AYA with cancer. Results: 12 students enrolled for the SSM over the year. All students found the placement widened their communication skills as well as their knowledge of AYA cancers and treatments. 4 main areas of learning were evident. 1.The problems faced by AYA patients as they try to establishing independent adult identities in the midst of severe illness or at the end of life and the implications for the triadic interview. 2. Information sharing during patient denial. 3. The AYA perspective: desire for control and their difficulty of communicating. 4.Challenges of communicating well in emotionally-charged situations. Conclusions: Experiential learning during the placement highlighted techniques for balancing both patient and parental involvement during consultations to maximise efficacy of information gathering. AYA cancer placements provide opportunities to develop advanced communication skills and can be augmented with experiential learning.

Evaluation of the effect of anew clinical reasoning curriculum in apre-clerkship clinical skills course.

IntroductionClinical reasoning is often not explicitly taught to novice medical students. Pre-clerkship clinical skills courses are an ideal venue to teach the clinical reasoning process. The aim of the study was to evaluate the impact of a preclinical clinical reasoning curriculum through an end-of-semester objective structured clinical examination.MethodsThis study was conducted through our longitudinal clinical skills course.Second year medical (M2) students who received the clinical reasoning curriculum in 2018 formed the study cohort. M2 students from the previous year, who did not have the clinical reasoning curriculum, formed the comparison cohort. Several modalities were used to teach clinical reasoning including whole case approach, serial cue approach, self-explanation of pathophysiological mechanisms and comparison of closely related diagnoses. The students interviewed a standardized patient and documented the history along with three likely diagnoses.ResultsStudents in the study cohort achieved higher scores on differential diagnosis (1.98 vs. 1.64 in the comparison cohort, p < 0.001). There was no statistically significant difference in the frequency of relevant symptoms queried between the study and comparison cohorts (3.74 vs. 3.34, p > 0.05).DiscussionOur study confirms that the introduction of clinical reasoning in a pre-clerkship clinical skills curriculum increases students’ ability to select relevant symptoms and provides them with a roadmap for expanding their differential diagnoses.

Development and Validation of a Bovine Castration Model and Rubric.

Veterinary students require deliberate practice to reach competence in surgical bovine castration, but animal availability limits opportunities for practice. We sought to create and validate a surgical bovine castration model consisting of a molded silicone scrotum and testicles to allow students to practice this skill without the use of live animals. We sought to validate the model and associated scoring rubric for use in a veterinary clinical skills course. A convenience sample of third-year veterinary students (n = 19) who had never castrated a bovine were randomized into two groups. The traditionally trained (T) group performed castration on a live bull calf after a 50-minute instructional lecture. The model-trained (M) group received the same lecture and a 2-hour clinical skills session practicing bovine castration using the model. All students were subsequently digitally recorded while castrating a live bull calf. Performance recordings were scored by an investigator blinded to group. Survey data were collected from the students and from expert veterinarians testing the model (n = 8). Feedback from both groups was positive. The M group had higher performance scores than the T group (M group, M = 80.6; T group, M = 68.2; p = .005). Reliability of rubric scores was adequate at .74. No difference was found in surgical time (M group, M = 4.5 min; T group, M = 5.5 min; p = .12). Survey feedback indicated that experts and students considered the model useful. Model training improved students' performance scores and provided evidence for validation of the model and rubric.

Expanding OSCE-related Learning Opportunities For Pre-Clerkship Students: Insights From an Assessment for Learning Curriculum.

Pre-clerkship clinical skills courses at many medical schools use objective structured clinical examinations (OSCEs) to assess students’ development as it relates to the foundational clinical skills of history taking, communication, and physical examination. The authors report on a curriculum in which OSCEs also serve as a springboard for additional learning by linking them to activities that include patient write-ups, oral presentations, clinical reasoning discussions, clinical question generation, and video review with faculty. The rationale for using OSCEs as an assessment for learning tool is discussed, and some lessons learned are reported.