Clinical Skills Examination Research Articles

Effect of Extrinsic and Intrinsic Stressors on Clinical Skills Performance in Third-Year Medical Students.

Both enhancements and impairments of clinical performance due to acute stress have been reported, often as a function of the intensity of an individual's response. According to the broader stress literature, peripheral or extrinsic stressors (ES) and task-contingent or intrinsic stressors (IS) can be distinguished within a stressful situation. The objective of this study was to assess the impact of IS and ES on clinical performance. A prospective randomized crossover study was undertaken with third-year medical students conducting two medical experiences with simulated patients. The effects of severity of the disease (IS) and the patient's aggressiveness (ES) were studied. A total of 109 students were assigned to four groups according to the presence of ES and IS. Subjective stress and anxiety responses were assessed before and after each experience. The students' clinical skills, diagnostic accuracy and argumentation were assessed as clinical performance measures. Sex and student-perceived cognitive difficulty of the task were considered as adjustment variables. Both types of stressors improved clinical performance. IS improved diagnostic accuracy (regression parameter β = 9.7, p = 0.004) and differential argumentation (β = 5.9, p = 0.02), whereas ES improved clinical examination (β = 12.3, p < 0.001) and communication skills (β = 15.4, p < 0.001). The student-perceived cognitive difficulty of the task was a strong deleterious factor on both stress and performance. In simulated consultation, extrinsic and intrinsic stressors both have a positive but different effect on clinical performance.

Use of simulators to explore specialty recommendation for a palpable breast mass

BackgroundThe aim of this study was to evaluate recommendation patterns of different specialties for the work-up of a palpable breast mass using simulated scenarios and clinical breast examination models. MethodsStudy participants were a convenience sample of physicians (n = 318) attending annual surgical, family practice, and obstetrics and gynecology (OB/GYN) conferences. Two different silicone-based breast models (superficial mass vs chest wall mass) were used to test clinical breast examination skills and recommendation patterns (imaging, tissue sampling, and follow-up). ResultsParticipants were more likely to recommend mammography (P < .001) and core biopsy (P < .0001) and less likely to recommend needle aspiration (P < .043) and 1-month follow-up (P < .001) for the chest wall mass compared with the superficial mass. Family practitioners were less likely to recommend ultrasound (P < .001) and obstetrics and gynecologists were less likely to recommend mammogram (P < .006) across models. Surgeons were more likely to recommend core biopsy and less likely to recommend needle aspiration across models (P < .001). ConclusionsRecommendation patterns differed across the 2 models in line with existing practice guidelines. Additionally, differences in practice patterns between primary care and specialty providers may represent varying clinician capabilities, healthcare resources, and individual preferences. Our work shows that simulation may be used to track adherence to practice guidelines for breast masses.

Diagnosing meniscal tears in the emergency department.

Acute meniscal knee injuries can lead to instability of the joint if they are left untreated, but clinical examinations of patients' acutely injured knees can be challenging because of the pain and swelling involved. Although magnetic resonance imaging and arthroscopy are the gold standard investigations for the diagnosis of meniscal tears they cannot always be carried out in acute or emergency department settings. It is therefore essential that emergency care practitioners have good clinical examination skills to ensure safe and effective patient management, diagnosis, and outcomes, as well as the skills and knowledge required to carry out meniscal tear tests. This article reviews the literature on the most common examination techniques associated with acute injuries, especially meniscal injuries, to knees: joint line tenderness assessment, McMurray's test and the Apley's grind test. It analyses the sensitivity and specificity for each test to help practitioners understand the clinical significance of positive and negative findings.

Training actors as standardized patients

Traditional medical education hasmostly applied written or oral examinations to assess professional education and training. However, it is doubtful whether these examinations can reflect the actual clinical competence of medical students. Students must show clinical ability in clinical situations rather than through written texts [1]. The focus of clinical learning should move from textbooks to actual patients because students understand that they can learn actual clinical skills only by interacting with patients and their families [2]. Using standardized patients (SPs) in teaching and assessment help students become familiar with clinical settings, thus benefiting not only their test scores but also patients and their families [3]. This helps fulfill the saying “Good teaching, as well as good mentors, cultivate good doctors.” The performance quality of an SP determines the reality of an entire clinical skills examination. The SPs, scenario design, and particularly, the SP training process, are crucial factors that contribute to the quality of the performance [4]. A clinical skills examination, which tests interpersonal and communication skills, is time consuming, and probably extremely repetitive, as it must be conducted several times a day. Therefore, the accuracy and consistency of the performance are themain factors contributing to the fairness and impartiality of the examination. As a result, SPs should be trained to retain their physical endurance and psychological stability during consecutive performances. This is similar to the

Comparison of glaucoma knowledge and referral practices among family physicians with ophthalmologists’ expectations

ObjectiveTo compare family physicians’ glaucoma knowledge and clinical skills with ophthalmologists’ expectations. DesignAn electronic cross-sectional survey of family physicians and ophthalmologists. ParticipantsParticipants included members of the Canadian Ophthalmological Society, Canadian Glaucoma Society, and the American Glaucoma Society, as well as family physicians in the Canadian Medical Directory and the Society of Rural Physicians of Canada listserv. MethodsTwo complementary surveys were developed to evaluate family physicians’ glaucoma knowledge and basic examination skills, and ophthalmologists’ expected level of family physician clinical knowledge and skills. χ2 tests identified differences between family physician and ophthalmologist responses. Differences in family physician knowledge based on practice location and frequency of patient visits with a diagnosis of glaucoma were also evaluated. ResultsA total of 142 ophthalmologists and 110 family physicians completed the survey. The majority (82%) of family physicians reported seeing patients with diagnosed glaucoma weekly, monthly, or semiannually. Significantly fewer family physicians than expected (p < 0.001) identified African descent (46%) and corticosteroid use (84%) as glaucoma risk factors. Family physicians were significantly less likely to refer based on risk factors (72%) than expected by ophthalmologists (91%; p < 0.001). Only 28% of family physicians were comfortable performing direct ophthalmoscopy, and 37% were comfortable checking for a relative afferent pupillary defect. A significant percentage of family physicians lacked knowledge of glaucoma medications (30%) and side effects (57%). ConclusionsThis study revealed significant disparities in family physician glaucoma knowledge, clinical examination skills, and referral practices. Educational materials should target these knowledge gaps.

A PILOT LOOKING AT “AN ADVANCED CLINICAL INDEPENDENT PRESCRIBING PHARMACIST”, MY PROSPECTIVE

Aim To assess the impact that a Clinical Independent Prescribing Pharmacist (IPP) could have on the workload of an Emergency Department in a specialist paediatric Hospital. This is part of the Health Education West Midlands Emergency medicine pharmacy work stream. Method This project consisted of three phases. Each phase entailed a clinical pharmacist being assigned to an Emergency Department at a different location. In order to demonstrate the viability of the role over a geographical and cultural cross section of the region, this was the site of phase II of the project. The pilot operated for 4 weeks, working on a variable shift pattern to encompass diurnal changes in patient throughput. Week one, time was spent in triage with nurses, who were responsible for taking observations, history and patients9 presenting complaints, Then applying triage categories; green (standard), yellow (urgent), orange (immediate) assessments required. The pharmacist would code each patient according to their perceived professional ability to manage (PAM) that patient. The categories were community pharmacy (CP), Independent prescriber (IP), Independent prescriber with additional training (IPT), Medical team (MT). Week two, tasks in Week 1 were repeated, but in addition, the patient was followed through their entire journey and each step being documented and categorised according to their PAM categorisation. In addition a day was spent with the emergency nurse practitioner (ENP), looking at minor injuries and a day reviewing all admissions for a 24 hour period, retrospectively assigning one of the four PAM categories. Week 3&4, an advanced nurse practitioner (ANP), a registrar and a consultant were shadowed with the aim of gaining a better understanding of more complicated cases. Each of the PAMs were then reviewed to assess what further training would be needed, to manage these patients. Results Over the four week period 401 patients were observed. Of these five (1.2%) were considered to be cases that could have been managed by a CP or an IP. 24 (6%) could have been dealt with by an IP with some input from a member of the medical team (MT). 172 (42.9%) could have been managed by an IPT, 200 (49.9%) cases required a member of the medical team (MT). Of the 201 patients assessed who were to be managed by CP, IP, IPT, 104 (51.7%) would require additional training in minor injuries and 90 (47.3%) would have required training in clinical examination and diagnostic skills. Conclusion The pilot was viewed positively by ED staff, including registrars. Consultants had concerns that more serious cases may not be assessed appropriately, or that the pharmacist would require too much support. In general the supervising Medical Consultant agreed with the PAMS assessments. This pilot indicated a new role could exist for Advanced Clinical Practice qualified pharmacists in Emergency departments.

Assessing knowledge, perceptions and attitudes to pain management among medical and nursing students: a review of the literature.

Chronic pain results in significant personal, societal and economic burden. Doctors and nurses have a pivotal role in patient pain management. In order to determine the effectiveness of current pain education on knowledge, attitudes and perceptions of medical and nursing students, there needs to be a valid measure to assess and quantify these domains. We reviewed the literature to identify approaches for assessing knowledge, perceptions and attitudes to pain management among nursing and medical students. Databases of peer-reviewed literature including CINAHL, EMBASE, ERIC, PsycInfo, Medline and PubMed were searched for articles published between 1993 and December 2014 using the following search terms: student, graduate, intern, junior, pain, pain management, analgesia, analgesic, pharmacology, pharmacological, knowledge, competence, attitude, preparedness, practice, nursing, medical, doctor, nurse. The search revealed over 3500 articles, and on application of the inclusion criteria, 26 articles were included in the review. A total of 14 instruments were used in these studies with the Knowledge and Attitudes Survey Regarding Pain (KASRP) as the main instrument in 9 out of the 26 articles. The various instruments used different question formats such as multiple-choice questions (MCQs), true/false statements and Likert scales that went from 3 points to 7 points. Clinical skills examinations were also used in four studies to assess pain management. There is no gold standard instrument currently used to assess knowledge, perceptions and attitudes to pain management. The results of this review showed, despite the diversity of standardised instruments that have been used to assess knowledge, perceptions and attitude to pain management, the literature has consistently reported that knowledge about pain management among nursing and medical students was generally poor among both groups.

The application of flipped classroom in pediatric physical therapy

Background: Flipped classroom is a novel pedagogical approach that promotes active learning in many fields of medical education. However, little is known about how to implement flipped classroom learning in pediatric physical therapy. Purpose: The paper reports the design, implementation, and evaluation offlipped classroom in pediatric physical therapy. Methods: Motor facilitation videos were uploaded to Youtube. The students were required to watch the videos and commend on-line before the class. The teacher designed classroom activities based on the student commends and key points of the topic. During the class, the students participated in classroom activities and demonstrated what they learned fromYoutube videos. The students observed the clinical skills of their peers andpoint outwhat needs to be refined in termsof the facilitation skills. The teacher answered the on-line commends and provided feedback for the demonstration of the students. Clinical skill examination and questionnaire were used to evaluate the outcome of the innovative pedagogy. Results: The final examination scores (78.96± 12.03) of the clinical skills were significantly higher than the midterm scores (70.24± 11.80). The students indicated watching motor facilitation video onYoutubewas helpful to their learning because they can watch the videos before and after the class for many times. They practiced the facilitation skills with their peers before the class. Their skills were refined during the class with commend of the teacher and peers. They also felt more confident for the performance in the final examination. Conclusion(s): Flipped classroom pedagogy can effectively promote the learning outcome in Pediatric Physical Therapy. The students achieved better scoreswithmore active and positive learning experiences. Implications: Flipped classroom pedagogy is feasible in the teaching of pediatric physical therapy.

G257(P) An overseas diploma in child health (dch) clinical training course and assessment programme-lessons learned

Introduction and aim Undergraduate and postgraduate education and training differ across nations in the emphasis placed on the knowledge, skills and attitudes within the training curriculum. In the DCH (UK) clinical examination, candidates are assessed in all areas of the doctor-patient interaction; skills in communication, proficiency in all areas necessary for a comprehensive assessment and management of the patient have to be demonstrated. This abstract describes the experience of doctors who participated in the first overseas RCPCH DCH (UK) clinical training course and pilot examination. Methods 5 UK faculty members supported by 5 Indian faculty members delivered a 2-day DCH (UK) training course and pilot assessment in India. 32 candidates attended, the target number set by the RCPCH. On day-1, training was provided around the stations in the examination circuit and feedback sought utilising a questionnaire survey represented on a scale of 1–5, 1 indicating very poor, 5 indicating excellent. Averaged scores are displayed graphically (Figure1). On day-2, a pilot examination was held, and feedback sought through a questionnaire survey utilising a 7-point Likert scale (Figure 2). Free text comments were invited on both days (Table 1). Results 29 of the 32 candidates provided feedback on day 1, 31 of the 32 on Day 2. Candidates expressed deep appreciation of this experience of teaching and training. They emphasised a desire to have further training, in all aspects of the course, stressing the importance for more-time and patient contact per session. They appreciated the different emphasis placed in UK postgraduate training, where communication, an empathetic approach, and good clinical examination and interpretive skills are the core skills assessed in our examination. The collaborative, supportive and welcoming approach displayed by the faculty of examiners was also widely appreciated. Conclusion The results obtained from this course provide evidence that such teaching and training is highly valued; with expressions of interest for further training. Pertinent feedback around how to improve future courses will be considered carefully and addressed in order to develop a sustainable overseas programme.

Peran Pelatihan Keterampilan Medik dan Kepaniteraan Klinik terhadap Kelulusan OSCE UKDI

Background: One of the areas of competence expected from a doctor in Indonesia is clinical skills. It will be assessed in the National Objective Structured Clinical Examination (OSCE). In the Faculty of Medicine Airlangga University, there are four clinical skill modules in second to fifth semester. Afterward, students go to clinical posting to apply their clinical skill and practice profesionalism to real patients. The objective of this study is to measure the correlation between clinical skill examination score, educational environment, and Grade Point Average (GPA) during clinical posting and National OSCE’s score.Method: This study used cross sectional approach. Data were obtained from 143 national OSCE’s participant. Primary data obtained from clinical posting’s educational environment questionnaire. Secondary data consisted of five categorized scores from clinical skill examination during preclinic; clinical posting GPA; and National OSCE’s scores. We conducted three different analyses: Spearman correlation test to measure the correlation of clinical skills examination scores to National OSCE’s scores; Pearson correlation test to measure the correlation of clinical posting GPA to OSCE’s scores; and correlation of clinical posting’s questionnaire to OSCE’s scores.Results: Clinical skills examination score was weakly correlated with OSCE’s score (r= 0,189, p&lt; 0,05). Clinical posting GPA was also correlated with OSCE’s score (r= 0,417, p&lt;0,001). But, there was no correlation of clinical posting’s educational environment with OSCE’s score (p&gt;0,05).Conclusions: There is a correlation between clinical skills examination scores and academic achievement during clinical posting with OSCE’s score. But, there is no correlation between clinical posting’s educational environment with OSCE’s score.

Application of nurse as standardized patients in hanging and choking rescue care training

Objective To explore the methods and effectiveness of using nurses as standardized patient (NSP) in junior nurses′ hanging and choking rescue care training. Methods This study selected four nurses as NSPs, based on Huaxi Hospital′s NSP screening criteria. A total of 60 nurses whose psychiatric nursing age were beyond three years were randomly divided into experimental group and control group, with 30 members each. The nurses in the experimental group were treated with NSP method, while the control group was trained in the regular way. After that, the effects of training were evaluated by Dundee Ready Education Environment Measure (DREEM). The theory and clinical skills examination and training satisfaction were surveyed. Results The theory test scores of the two groups after training were significantly higher than those before training (P 0.05). The total score of DREEM, and the perception of learning, course organizers and academic self-perception score of DREEM of the experimental group were significantly higher than those of the control group (t=7.086, 9.443, 10.462, 8.620, respectively; P 0.05). There was no significant difference in the satisfaction between the two groups (P>0.05). Conclusions The application of NSP in hanging and choking rescue care training can improve the teaching environment, increase nurses′ choking rescue care skills, but no difference is found in the theory examination and hanging rescue care skills between the two groups. Key words: Nursing education; Rescue; Nurse as standardized patient; Hanging; Choking

Introduction of an interprofessional oral health curriculum.

Physician assistants can incorporate a variety of oral health services into their practices, but many physician assistant programs do not dedicate adequate time to oral health education. Our goal was to develop a novel and interprofessional oral health education curriculum model for our physician assistant students that could be adopted by other physician assistant programs and dental schools in the United States. Curricula were created collaboratively and taught by dental school faculty with a focus on the primary care setting. Prewritten and postwritten tests were administered along with a clinical skills examination. Student and faculty evaluations were administered for pedagogical evaluation. Pretests and posttests demonstrated a 25% increase in knowledge acquisition (paired t test: P < .001). Physical examination skills testing achieved a 95% completion rate. Student and faculty evaluations demonstrated high satisfaction rates with the curricula delivery. Initial evaluation of this novel interprofessional curriculum for physician assistant students demonstrates that it was successful. It was well-received by the students and the faculty members and resulted in measurable knowledge acquisition. This model could feasibly be reproduced in other institutions for oral health education.

Effect of early clinical skills teaching on 3rd year medical students' learning: The student perspective

Abstract Objectives The main purpose of the early introduction of Clinical Skills Learning (CSL) to pre-clinical years is to allow medical students to gain experience in clinical examination skills, basic medical procedures, history-taking and clinical communication. The objective of this study was to determine the effectiveness of the early teaching of clinical skills in preparing medical students for their clinical years. Methods A validated questionnaire assessing the value of CSL on students in their first clinical year was distributed to 3rd year medical students. The questionnaire consisted of 8 items with a five-point Likert scale and one open-ended question. Results The response rate to the questionnaire was approximately 62%. Nearly 97 (70.8%) students suggested that CSL was a favourable teaching strategy. A high percentage of students (90.5%) agreed that CSL was a useful pre-clinical module to prepare them for their clinical years. The students gave positive feedback on the teaching of history-taking and physical examination, exposure to the hospital environment and acquisition of communication skills with supervisors and patients. No student perceived the CSL module as poor. Conclusions Early CSL was well-perceived by students in preparing them for their clinical years. CSL is a vital part of the pre-clinical curriculum and should be further enriched with frequent hospital visits to enhance students' confidence level and performance when interacting with patients during their clinical years.

Medical Students in Breast Clinics—How Welcome Are They and How Can We Improve Their Learning Opportunities?

Clinical examination skills are an essential component of medical education, with students having the opportunity to practice important skills to facilitate their learning. The opportunities to practice intimate examinations, however, can be varied, with a number of patients declining to give consent, limiting the learning opportunities in clinic. This study aimed to identify whether patient demographics correlated with varying degrees of consent toward student participation. A questionnaire was distributed to patients attending a surgical preassessment clinic with confirmed breast pathology regarding their attitudes toward different roles they were happy for students to have in their treatment journey. These results were analyzed using SPSS 20. Overall, 111 patients responded, aged between 17 and 86 years; 42 (38%) were under the care of a male surgeon. Patients under the care of a female surgeon were less likely to agree to students being in clinic (p = 0.009), take a history (p = 0.012), or examine them (p = 0.019). Increasing age was associated with increased agreement to being examined (p = 0.028), but there was no correlation between clinic attendance frequency and acceptance of students. Our findings suggest patients under the care of a male surgeon were more likely to consent to history taking and examination by students, though this may be owing to patient selection bias. Older patients were more likely to consent to being examined, though previous clinic attendance did not improve consent to medical students.

Performance in physical examination on the USMLE Step 2 Clinical Skills examination.

To provide descriptive information about history-taking (HX) and physical examination (PE) performance for U.S. medical students as documented by standardized patients (SPs) during the Step 2 Clinical Skills (CS) component of the United States Medical Licensing Examination. The authors examined two hypotheses: (1) Students perform worse in PE compared with HX, and (2) for PE, students perform worse in the musculoskeletal system and neurology compared with other clinical domains. The sample included 121,767 student-SP encounters based on 29,442 examinees from U.S. medical schools who took Step 2 CS for the first time in 2011. The encounters comprised 107 clinical presentations, each categorized into one of five clinical domains: cardiovascular, gastrointestinal, musculoskeletal, neurological, and respiratory. The authors compared mean percent-correct scores for HX and PE via a one-tailed paired-samples t test and examined mean score differences by clinical domain using analysis of variance techniques. Average PE scores (59.6%) were significantly lower than average HX scores (78.1%). The range of scores for PE (51.4%-72.7%) was larger than for HX (74.4%-81.0%), and the standard deviation for PE scores (28.3) was twice as large as the HX standard deviation (14.7). PE performance was significantly weaker for musculoskeletal and neurological encounters compared with other encounters. U.S. medical students perform worse on PE than HX; PE performance was weakest in musculoskeletal and neurology clinical domains. Findings may reflect imbalances in U.S. medical education, but more research is needed to fully understand the relationships among PE instruction, assessment, and proficiency.

Investigating Patient and Physician Delays in the Diagnosis of Head and Neck Cancers: a Canadian Perspective.

Diagnostic delays for head and neck cancer (HNC) patients are common. Patients often disregard symptoms for long periods before seeking help, and some family physicians may not be alert to the warning symptoms and signs of HNCs. This study evaluated the factors associated with length of delays in the diagnosis of HNCs in a Canadian population. This was a mixed-method study consisting of patient interviews and surveys in an academic health center. A questionnaire requesting demographic and disease information was completed by HNC patients followed by a 30 min semi-structured interview in a private setting. Interviews were audio recorded, transcribed, anonymized, and descriptively coded for emergent themes. Twenty-eight head and neck cancer patients participated in the study. More patients experienced physician delay (71 %) than patient delay (36 %). The median physician delay and patient delay were 108 and 31 days, respectively. Two main themes regarding these delays were (1) physician lack of knowledge and (2) lack of patient awareness. Results indicate that physician delay needs to be focused on compared to patient delay, as it is more common and has longer delays. More comprehensive training in head and neck clinical examination skills during undergraduate and residency training is recommended to reduce physician delay. Patient delay could be targeted by public education programs via both physicians and dentists.

Anatomical sketching and education: The next steps

Sir, Noorafshan et al. have reported an insightful account into their experience of using simultaneous anatomical sketching as a “learning by doing” method of teaching human anatomy.[1] As the authors state, too much medical education is a passive experience and anything that can help students take an active part in the learning experience is bound to be a good thing. The authors have gone some way toward evaluating their pedagogical innovation – but they still have some way to go before they can definitely state that this is an effective pedagogy. They have certainly demonstrated feasibility and students broadly like and enjoy the approach. However, there are further evaluation steps that should now be taken. First of all they should consider finding out what effect this new innovation has on the anatomical knowledge of the students. A controlled trial may be necessary in this regard. Second, an effective pedagogy will have a positive effect on skills as well as knowledge. This new pedagogy would ideally have an effect on skills. Also, yet this might be difficult to evaluate in students who are in a traditional curriculum where they learn anatomy first in their preclinical years and then learn the application of anatomy in the various clinical specialties subsequently. This is really an argument for integration of the curriculum – whereby students learn preclinical and clinical knowledge and skills together and at the same time learn how to integrate these. In this way, the authors would find out if their innovation had an effect on clinical examination skills. Third and last it would also be interesting to conduct a cost analysis of their approach – to see if in fact they had discovered a low cost and yet highly effective method of learning anatomy.[2] This would then certainly be worthwhile rolling out in other institutions. Yours Sincerely,

Evaluation of teaching and learning in family medicine by students: a sri lankan experience.

Background:Family Medicine occupies a prominent place in the undergraduate curriculum of the Faculty of Medicine, University of Kelaniya, Sri Lanka. The one month clinical attachment during the fourth year utilizes a variety of teaching methods. This study evaluates teaching learning methods and learning environment of this attachment.Methodology:A descriptive cross sectional study was carried out among consenting students over a period of six months on completion of the clinical attachment using a pretested self administered questionnaire.Results:Completed questionnaires were returned by 114(99%) students. 90.2% were satisfied with the teaching methods in general while direct observation and feed back from teachers was the most popular(95.1%) followed by learning from patients(91.2%), debate(87.6%), seminar(87.5%) and small group discussions(71.9%). They were highly satisfied with the opportunity they had to develop communication skills (95.5%) and presentation skills (92.9%). Lesser learning opportunity was experienced for history taking (89.9%), problem solving (78.8%) and clinical examination (59.8%) skills. Student satisfaction regarding space within consultation rooms was 80% while space for history taking and examination (62%) and availability of clinical equipment (53%) were less. 90% thought the programme was well organized and adequate understanding on family medicine concepts and practice organization gained by 94% and 95% of the students respectively.Conclusions:Overall student satisfaction was high. Students prefer learning methods which actively involve them. It is important to provide adequate infra structure facilities for student activities to make it a positive learning experience for them.

Progress testing 2.0: clinical skills meets necessary science

IntroductionProgress testing has been widely used in medical schools to test scientific knowledge but has not been reported for assessing clinical skills.DevelopmentWe designed a novel progress examination that included assessments of both clinical performance and underlying basic and social science knowledge. This Progress Clinical Skills Examination (PCSE) was given to 21 early medical students at the beginning and end of a 6-week pilot test of a new medical school curriculum.ImplementationThis examination was feasible for early students, easy to map to curricular objectives, and easy to grade using a combination of assessment strategies.Future directionsUse of a PCSE is feasible for early medical students. As medical schools integrate clinical experience with underlying knowledge, this type of examination holds promise. Further data are needed to validate this examination as an accurate measure of clinical performance and knowledge.

The Use and Evaluation of an Inexpensive Eye Model in Direct Ophthalmoscopy Training

Purpose Learning direct ophthalmoscopy to view the fundus is an important skill that is often given insufficient attention in medical school curriculums. The goals of this study were to (1) create an easy-to-assemble, inexpensive artificial eye model, the FAK-I, (2) develop an objective evaluation tool to assess the students' clinical skills in using the direct ophthalmoscopy, and (3) determine if practice with the FAK-I translates into improved clinical examination skills. Methods After an initial hands-on tutorial on direct ophthalmoscopy, study subjects (n = 12) were randomly assigned to a control group (n = 6), which received no FAK-I model, or a study group (n = 6), which received a FAK-I model. After 45 days of no further intervention, students took an objective evaluation of clinical direct ophthalmoscopy skills. Scores of students in the control and study group were compared. Results The study group had a higher percentage of correct responses (44%) compared with the control group (40%), but the difference did not reach statistical significance. More students in the study cohort (50%) reported independently practicing the direct ophthalmoscope than the control group (0%). The study cohort also reported practicing on the FAK-I more frequently than on peers or patients. Conclusions We were able to create the FAK-I, a simple low-cost eye model to practice direct ophthalmoscopy. We also designed an objective evaluation tool to assess students' clinical skills with a direct ophthalmoscope. While the study group scored slightly better than the control group, these numbers did not reach significance due to the limited size of this pilot study. The study group practiced more than the control group, and more often on the FAK-I model than on peers or patients. These findings in this pilot study point to the potential utility of providing a simple eye model in improving direct ophthalmoscopy skills in medical students.