Competence In Clinical Skills Research Articles

The effect of standardized patients for physical therapy students on behaving and communicating as a professional: a systematic review

Background Previous systematic review and meta-analysis examining standardized patients (SPs) in Physical Therapy (PT) education yielded 14 articles describing 16 studies; 10 addressed professional behaviors (PB), and six reported providing SP feedback to students. Of those six studies, four were randomized controlled trials (RCTs) emphasizing SP feedback on clinical competencies. Only two studies examined PB or communication in PT students after receiving SP feedback. There appears to be a gap within the current literature to understand better SPs’ ability to impact PT students’ communication and PB as they prepare for clinical education. This systematic review aimed to synthesize and critically appraise the findings of empirical studies (qualitative or quantitative) evaluating the contribution of SPs on the student’s affective learning domain (professional behavior and/or communication) in PT entry-level education. Methods A systematic review was completed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines for Reporting Systematic Reviews on December 1, 2021, using the following electronic databases PubMed, Cochrane Central Register of Control Trials, CINAHL, ERIC, SCOPUS, and Web of Science. Article inclusion criteria: peer-reviewed, assess PT students, assess the affective learning domain, intervention using live, standardized patient learning experiences, and be written in the English language. Studies were excluded if they involved peer-role play as the (SP) or if the authors did not describe the SP process. The risk of bias was evaluated through the Critical Appraisal Skills Programme tool (CASP), given the heterogeneity of study types anticipated for this systematic review, and PEDro if the study design was a RCT. Results There were ten included studies in this review. Two studies were RCT designs that explored Immersive Simulation-Based Learning Experience (SBE) in the clinic’s impact on PB, and all used the Assessment of Physiotherapy Practice (AAP) outcome measure. The other seven studies examined SPs or SBE on PB within the classroom and had significant heterogeneity based on study design and outcomes reported. Discussion Summative results suggest that SP or SBE has some unique attributes, if applied in the clinical environment, may improve students’ PB and core values development, consistent with a PT practice. This systematic review may inform academic leadership and clinical educators in physical therapy education delivery. Integrating experiential and simulated learning experiences into a program may increase efficiency by allowing students to demonstrate clinical competence skills sooner. Limitations Heterogeneity of study design and reported outcomes limited the results and pooling of data.

Comparing perceptions of nursing faculty and students to actual student performance in syringe measurement and use: An example of the Dunning-Kruger effect?

Introduction: A vital component of nursing education is the evaluation by faculty of student nurse’s skill competence. Erroneous estimations of skill competence, as in syringe measurements and dosages, can be critical to patient safety. The Dunning-Kruger effect describes the overestimation/underestimation of skill competence. It is the professional responsibility of faculty and students to be able to assess actual versus perceived competence levels accurately. Purpose: The purpose of this study was to compare the perceptions of nursing faculty and nursing students to student actual competence in syringe measurement and usage. Methods: A cross-sectional, descriptive, comparative study conducted in a School of Nursing Skills Laboratory. Participants included faculty and 3rd and 4th year nursing students. Results: The study sample included 96 students and 30 faculty members. Significant differences were found between faculty perception and student perception of competence (p=0.001). The actual successful performance of all students was lower than expected; 3rd year students had a higher perception of their skill competence than their actual performance, and 4th year students performing at a lower level than 3rd year students (p=0.001). Discussion: Nursing faculty educators and upper-class nursing students perceived a higher level of competence than actual performance. This supports the Dunning Kruger effect and behooves nursing faculty and students to be more precise in their assessments. Conclusions: In today's milieu of online teaching, keen awareness and objectivity regarding clinical skills competence is imperative for client safety. A longitudinal study measuring perception of competence as compared with actual skill performance is warranted.

THE IMPACT OF INDONESIAN MEDICAL DOCTORS NATIONAL COMPETENCY EXAMINATION (IMDNCE) TOWARDS LEARNING AND CLINICAL PRACTICES: A QUALITATIVE STUDY ON THE INTERNSHIP DOCTORS’ PERSPECTIVES

Background: The implementation of the national licensing examination for medical doctors is expected to have a broad impact on doctors and society. Indonesian Medical Doctor National Competency Examination (IMDNCE; Indonesian: Uji Kompetensi Mahasiswa Program Profesi Dokter or UKMPPD) as an ‘exit exam’ in the medical education process may significantly impact learning and clinical practices. The study’s objective was to explore the impact of IMDNCE on both the learning and clinical practices of doctors.Methods: The study subjects were internship doctors who had passed the IMDNCE. Participants were recruited by purposive sampling based on the ownership status of the institution (state/private) and the accreditation of respective medical schools and participants’ gender. The study participants consisted of 41 internship doctors working in 6 regions from 33 different medical schools out of 75 medical faculties in Indonesia.Results: IMDNCE has a positive influence on learning and clinical practice. The IMDNCE process emphasizes standard competencies that must be mastered and patient management process with current evidence that is not always achieved during clinical education, increasing clinical knowledge and skills, and increasing awareness of professional development. IMDNCE also has very well affected in the development of self-confidence and a sense of responsibility which are essential in clinical practice. In addition to psychological influences, IMDNCE improves competence in clinical skills and promotes good medical practice.

Effectiveness of an Integrated Simulation in Teaching Clinical Social Work Skills: Geriatric Mental Health Proficiency

ABSTRACT Nationally, social work students face limited access to clinical education that examines the intersection of older adults, chronic disease, and mental health. This is critical due to a rapidly aging population and a shortage of geriatrics trained social workers. Scant data exists on the effectiveness of clinical simulations to prepare social work students in geriatrics and mental health specialties. In this study, 118 MSW students completed a simulation through the Standardized Patient (SP) Program consisting of a gerontology course, patient interview, debriefings, self-efficacy and counseling skill outcomes, and qualitative surveys. Students reported gains in knowledge, counseling self-efficacy, and clinical skill competency. Simulations assess students in clinical scenarios to improve counseling skills towards achieving clinical competency.

Assessment of clinical skill competency of medical postgraduate students – Recommendations for upcoming CBME curriculum for postgraduates

Direct observation of postgraduate medical trainees with actual patients by clinical faculty has traditionally been a standard tool to assess knowledge and skills in clinical subjects. By assessing and providing feedback to medical trainees performing a medical interview, physical examination, or counselling patients, faculty can facilitate budding physicians to have successful practice of medicine in their future. Despite the advances in clinical skills evaluation, direct observation has been a most popular and time tested method. However, observation of postgraduate medical students by faculty is very subjective and unfortunately often sporadic and non-standardized. Substantial amount of literature identifies several threats to its construct validity as an assessment tool. Although many tried to demonstrate methods to minimize those threats, there are many lacunae that remain inherent to direct observation method. Hence the need of the time is to relook at the observation as an assessment tool, instead of discarding the whole as inappropriate one. The authors initially made an effort to analyse the problems in present settings in India. After an extensive literature search authors advocate few additions and modifications to the existing system. Thus the present study not only highlights the pitfalls in the direct observation method but also suggests solutions for the problem.

Obstetrics and Gynecology Residents Self-perceived Competency Regarding Female Pelvic Medicine and Surgery: An Internet-based Cross-sectional Survey

Background: The aim of our study was to assess factors associated with residents’ perceived competency regarding female pelvic medicine and reconstruction surgery (FPMRS).
 Methods: We conducted an Internet-based cross-sectional survey. Obstetrics and gynecology residents’ self-perceived competence in clinical skills for management of pelvic floor disorders were questioned. Competency in different aspects was analyzed concerning the availability of fellowship-trained professor, rotation, and fellowship training program.
 Results: 1168 residents of four levels of residency participated in this study. 760 (65.06 %) of residents were not trained by a fellowship-trained attendant. Of 409 (35.01%) responders who were trained by board-certified fellowship, 334 had FPMRS rotation in their residency program. Senior residents were significantly more confident than residents in the first and second years. 695 (59.50 %) of residents reported participating in the pelvic floor surgeries; however, only 15.3 % were served as primary surgeons. Where pelvic floor education had been provided by a fellowship-trained attendant, more perceived competency was evident in all fields of clinical skills except performance as primary surgeon and management of emergency cases. Among residents trained by board-certified FPMRS attendants, there were no significant differences regarding FPMRS rotation or fellowship training programs. 88.69 % of residents declared that a comprehensive course in the field of FPMRS is needed in the residency curriculum.
 Conclusion: This study demonstrates that being trained by board-certified FPMRS attendants has significant effect on residents’ self-perceived competency. Residency education was not compromised by fellowship training program.

The Evaluation of North Wales SPiCE: Special Preparation in CASC Examination

AimsAs part of the effort to support core psychiatry trainees in North Wales to prepare for their CASC (Clinical Assessment and Skill Competency) exam, the North Wales SPiCE (Special Preparation in CASC Examination) Project has been initiated. This article aims to evaluate the SPiCE based on medical educational principles.MethodsA total of five candidates preparing for the CASC exam expressed interest and an organising committee was set up. Examiners consisted of a consultant and four specialist registrars while role players were recruited from non-exam sitting junior trainees. Five mock CASC stations were written and role-players were calibrated accordingly. The stations included: History taking for a patient with FTD (frontotemporal lobe dementia), MSE (Mental state examination) of a patient with mania and psychosis, explanation of CBT (cognitive-behavioural therapy), breaking bad news of NMS (neuroleptic malignant syndrome), and explanation of ECT (electroconvulsive therapy). The mock exam was conducted virtually using Microsoft TeamsTM. The specialist registrars’ performances in feedback provision were assessed for their teaching using the AOT (Assessment of Teaching) form by the consultants. For core trainees who had played the part of organising committee members and role players, their volunteerism and educational management experience were assessed using the DONCS (Direct Observation of Non-clinical Skill) form by specialist trainees.ResultsAll five candidates passed all the stations (consists of both borderline pass, pass) in the mock exam with 25% improvements in confidence level were seen among candidates in four stations, i.e. ECT explanation, breaking bad news of NMS, CBT explanation, and MSE of a patient with mania and psychosis. All candidates feel the SPiCE programme was useful in helping their final preparation and they would recommend it to other candidates. Four of the candidates sat for the immediate CASC diet after the SPiCE received a pass result. All specialist registrars received positive AOT feedback for their teaching and all non-exam sitting junior trainees received positive DONCS feedback for their spirit of volunteerism and collaborative teamwork.ConclusionThe main strength of the SPiCE project is it utilises existing resources and volunteerism of the organising committee while its main limitation is it has only five stations rather than 16 stations in the real exam. Although the mock exam has improved the confidence of candidates and the majority of candidates pass the exam immediately after that, the causal link between the SPiCE and candidates’ results cannot be conclusively established given all candidates have a good baseline.

New approach to learning medical procedures using a smartphone and the Moodle platform to facilitate assessments and written feedback

Background: To overcome communication obstacles between medical students and trainers, we designed serial learning activities utilizing a smartphone and web-based instruction (WBI) on the Moodle platform to provide clear and retrievable trainer feedback to students on an objective structured clinical examination (OSCE) item. Methods: We evaluated students’ learning achievement and satisfaction with the new learning tool. A total of 80 fourth-year medical students participated. They installed the Moodle app (the WBI platform) on their smartphones and practiced an endotracheal suction procedure on a medical simulation mannequin while being evaluated by a trainer regarding competence in clinical skills on the smartphone app. Students’ competency was evaluated by comparing the scores between the formative assessment and the summative assessment. The degree of satisfaction and usefulness for the smartphone and WBI system were analyzed. Results: The means (standard deviations, SDs) of the formative and summative assessments were 8.80 (2.53) and 14.24 (1.97) out of a total of 17 points, respectively, reflecting a statistically significant difference (P<0.05). The degree of satisfaction and perceived usefulness of the smartphone app and WBI system were excellent, with means (SDs) of 4.60 (0.58), and 4.60 (0.65), respectively. Conclusion: We believe that the learning process using a smartphone and the Moodle platform offers good guidance for OSCE skill development because trainers’ written feedback is recorded online and is retrievable at all times, enabling students to build and maintain competency through frequent feedback review.

After the Discontinuation of Step 2 CS: A Collaborative Statement from the Directors of Clinical Skills Education (DOCS)

Issue: The United States Medical Licensing Exam (USMLE) Step 2 Clinical Skills Examination (Step 2 CS), the only clinical skills competency testing required for licensure in the United States, has been discontinued. Evidence: This exam, though controversial, propelled a movement emphasizing the value of clinical skills instruction and assessment in undergraduate medical education. While disappointed by the loss of this national driver that facilitated standardization of clinical skills education, the Directors of Clinical Skills Education (DOCS) see prospects for educational innovation and growth. DOCS is a national organization and inclusive community of clinical skills education leaders. This statement from DOCS regarding the discontinuation of USMLE Step 2 CS has been informed by DOCS meetings, listserv discussions, an internal survey, and a review of recent literature. Implications: Rigorous clinical skills assessment remains central to effective and patient-centered healthcare. DOCS shares specific concerns as well as potential solutions. Now free from the external pressure to prepare students for success on Step 2 CS, clinical skills educators can reprioritize content and restructure clinical skills programs to best meet the needs of learners and the ever-evolving healthcare landscape. DOCS, as an organization of clinical skills leaders, makes the following recommendations: 1) Collaboration amongst institutions must be prioritized; clinical skills assessment consortia should be expanded. 2) Governing, accrediting, and licensing organizations should leverage their influence to support and require high quality clinical skills assessments. 3) UME clinical skills leaders should develop ways to identify students who perform with exceptional, borderline, and poor clinical skills at their local institutions. 4) UME leadership should fully commit resources and curricular time to graduate students with excellent clinical skills.

166 Sequential Simulation as Replacement for Standard 4-Week Practice-Based Learning (PBL) for First-Year Undergraduate Physiotherapy Students

Practice-based learning (PBL) via clinical placement is a core part of a physiotherapy degree with the Chartered Society of Physiotherapy (CSP) requiring completion of 1000 placement hours. The COVID-19 pandemic resulted in cancellation of placements on top of an already saturated geographical placement provision in certain regions with many Higher Education Institutes (HEI) reporting a backlog of placements. Inability to meet requisite placement hours impacts on student progression, reducing the flow of physiotherapists into the workforce at a time when Allied Heath Professions (AHP) growth has been planned. The CSP and Health and Care Professions Council (HCPC) have both encouraged HEIs to be innovative in placement provision in response. Simulation is widely utilized in healthcare training but remains an emerging concept in terms of placement replacement The aim was to develop a fully simulated placement that replicated the learning objectives achievable through standard PBL.Development of a novel placement model to deliver a fully simulated placement as replacement for a standard 4-week clinical placement scheduled for 15 (20% cohort) first-year physiotherapy students.The placement was split across clinical specialities within cardiorespiratory and musculoskeletal physiotherapy. Key objectives were set weekly: week 1, focussing on communication/patient-centred care (scaffolded across subsequent 4 weeks); week 2, focussing on assessment, patient management and clinical reasoning; week 3, consolidation of clinical reasoning; week 4, case presentation. Sequential simulation was utilized to best replicate clinical practice, following simulated patients from pre-admission/injury, through to admission, deterioration, rehabilitation and long-term management. This approach enabled learners to experience a full patient journey, unachievable through standard placement timelines. Simulation using a mixed approach to facilitation and PEARLS debrief, handover tasks, multi-disciplinary team meetings, discharge planning and smaller vignette scenarios to develop specific clinical skills were simulated utilizing actor role players, high-fidelity manikins and peer enhanced e-learning. The placement modelled a CLiP (collaborative learning in practice) delivery, an approach promoted across standard placements by HEE, with students autonomously setting objectives, utilizing across level learning, recording of daily learning logs, reflections and peer assessments. Pre- and post-placement data have been gathered exploring the students’ experiences, expectations, and attitudes towards simulated placement, competence and confidence in both communication and clinical skills using focus group interviews and questionnaires.

Picture guided learning - A picture-based clinical skill teaching resource in undergraduate nursing in South Australia

A competent nursing graduate is required to perform psychomotor skills related to clinical procedures, articulate knowledge to support their activities, work in a team with efficient time management skills and have strategies to perform in the increasingly busy clinical environment and with complex patient acuity. Student Evaluation of Teaching data from an undergraduate nursing clinical subject 2014-2018 identified an inconsistency in clinical skill teaching/delivery by educators which needed to be addressed. This study aimed to evaluate the outcome of implementing the Clinical Skill Storybook as an additional teaching resource for students’ clinical skill development. A descriptive analysis approach was applied to summarise quantitative and qualitative subject evaluation data along with Clinical Skill Storybook evaluation questionnaires (2018-2020). Data analysis identified five themes: (1) Clinical Skill Storybook as a Learning Resource, (2) Self-directed learning and peer support, (3) Developing clinical skill competency, (4) Preparation for clinical placement, and (5) Maintaining teaching consistency. It was evident that the Clinical Skill Storybook provided an easy-to-follow visual guide which assisted students’ confidence and competence of skill development. The subject evaluation highlights that students were significantly more satisfied with the teaching resources than in previous years. The implementation of the Clinical Skill Storybook actively improved students’ skill acquisition, confidence, and readiness for placement. The findings indicated that picture-based resources such as the Clinical Skill Storybook are beneficial for nursing students’ clinical skill development. Further involvement with stakeholders such as clinical venues in developing the clinical skill storybook is planned for future exploration.

Improving Feedback for Hematology and Oncology Fellows Via Virtual Workshops: Sustainability Analysis

BackgroundEffective feedback is an important tool in medical education for the learning and growth of trainees and for faculty development. It allows learners to remain on course in reaching competence in clinical, research, and interpersonal skills, yet the impact of teaching feedback during hematology-oncology training has not been studied in depth. To tackle the lack of effective constructive feedback within our hematology oncology fellowship program, we initiated a quality improvement (QI) project to identify barriers in delivering and receiving high-quality feedback in the program and to create a curriculum aimed at teaching fellows and faculty how to engage in more effective feedback conversations. In the initial phase of the pilot study, a pre-intervention survey identified the two main barriers for effective feedback in our program as discomfort in giving feedback and lack of protected time. A virtual workshop improved quality of feedback by addressing these barriers and providing tools necessary to give and receive constructive feedback. We aimed to highlight the sustainability of these interventions.MethodsUtilizing the results of the pre-intervention survey, we built three 2-hour interactive virtual workshop sessions conducted through the ASCO Quality Training Program. Skills that were emphasized and practiced included appropriate set-up, low-inference observations, dialogic feedback conversations and a structured approach to reinforcing and modifying feedback. A follow up session was conducted three months later allowing for reinforcement of the skills. Post-intervention surveys were given immediately after the initial workshop and after the follow-up session. All surveys were identical employing Likert scale and open-ended questions. Weekly email reminders for protected feedback time were also set up. This project was developed through the ASH Medical Educators Institute.ResultsEleven out of 15 attendees completed each of the questionnaires. At baseline, 81.8 % of the participants reported they do not have protected time to complete evaluations. This decreased to 63.6% immediately post-intervention and to 27.3% at the three-month point. Similarly, only 65.5% of the participants reported they were comfortable giving feedback prior to the workshop, increasing to 81.8% immediately after the intervention and was sustained at 81.8% at three months. Half of the participants reported that the feedback was not actionable in the initial questionnaire, decreasing to 10% post-intervention. Majority of the participants agreed that the workshop helped address barriers for effective feedback in our program.ConclusionsThis study showed the sustainability of positive changes, even during the COVID-19 pandemic, for giving and receiving quality feedback implemented in our fellowship program. Its outcomes are salient given that it utilizes a simple intervention that could be expanded to other training programs as feedback is a systemic problem in medicine. It also underscores the importance of formal workshops in overcoming barriers for effective feedback. Limitations of this QI study include the small sample size and single-institutional design. Our future goals include incorporating a formal yearly curriculum assigning weekly protected time for feedback to ensure these results are sustainable and reproducible with incoming fellows. DisclosuresNo relevant conflicts of interest to declare.

Temporal changes in medical student perceptions of their clinical skills and needs using a repeated self-assessment instrument

BackgroundMedical student needs in clinical skill training may change over time, but data on this topic are limited. This study uses repeated self-assessments on clinical rotations during medical school to evaluate students’ perceptions of their clinical skill growth.MethodsA self-assessment rating was completed by students during each clinical rotation as they progressed through their core clinical rotation year. The instrument consisted of questions on 5 clinical skill categories where students rated their performance as “below”, “at” or “above” expected, and open-ended questions on strengths and challenges. We evaluated changes in self-ratings between the first (n=136) and third (n=118) quarters by matched-pair analysis of the shift in responses between time points using a Sign Test. We also identified the main themes from the students’ responses to open-ended questions.ResultsWe found 22.4 % and 13.3 % of students increased their self-assessment ratings on “Oral Presentation Skills” and on “Differential Diagnosis”, respectively. In contrast, perceived ability to communicate with patients saw the largest negative shifts. “Patient Interaction” was the most commonly identified area of strength and “Knowledge and Organization” was most frequently cited as a barrier.ConclusionsStudents demonstrated a positive shift in perceived competence in some core clinical skills that are not strongly emphasized in the preclinical curriculum, likely reflecting increased exposure over time. However, their perceived competence in communication skills declined. This may reflect initial over-estimation or true decline due to competing needs/interests. These patterns of change can inform the design of longitudinal curricula that anticipate and address students’ needs during clinical rotations, such as placing increased emphasis on presentation skills and differential diagnosis earlier in the curriculum, and adding more emphasis to communication skills in later phases.

Developing a Standardized Method for Clinical Staff Training, Education, and Competency.

Clinical skill competency maintenance is a regulatory and quality requirement, making it top priority for healthcare organizations. Staff having the proper clinical competencies to provide high-quality care begins with nursing orientation and continues with the maintenance of annual skill competency. Building a robust training and clinical competency program requires collaboration between nursing education and nursing leadership. This project describes a model for nursing orientation and continued training in an ambulatory care setting.

Improving feedback for hematologists and oncologists in training.

11025 Background: Feedback is an integral part of the learning process, allowing learners to remain on course in reaching competence in clinical, research, and interpersonal skills. However, the impact of teaching feedback during hematology-oncology training has not been studied. We aimed to identify barriers in delivering and receiving high-quality feedback in our fellowship program and to create a curriculum aimed at teaching fellows and faculty how to engage in more effective feedback conversations. Methods: This pilot study aimed at determining and addressing perceived barriers to high-quality feedback in the hematology-oncology fellowship program. A pre-intervention questionnaire, consisting of Likert scale and open-ended questions, was administered to identify barriers to giving feedback and to assess satisfaction with the quality of feedback received in our fellowship program. The results of the baseline questionnaire were utilized to build a virtual interactive three-session workshop provided by the ASCO Quality Training Program in which the importance of feedback and methods of providing effective feedback were taught. Topics included feedback set-up, low-inference observation, and a structured approach to reinforcing and modifying feedback. One month after the intervention the participants completed a follow up questionnaire. This project was developed through the ASH Medical Educators Institute. Results: Each questionnaire was completed by 11 participants. The two main barriers to high-quality feedback identified were the discomfort with both giving and receiving feedback, and the lack of protected time. At baseline only 54% of the participants reported they were comfortable giving feedback, increasing to 81% post- intervention. Pre-intervention, 81% of participants reported they did not have protected time for feedback, decreasing to 64% after the intervention and institution of weekly protected time for feedback. Half of the participants reported that the feedback was not actionable in the initial questionnaire, decreasing to 10% post-intervention. Overall, fellows reported that their feedback was mostly focused on notes, followed by presentations and interpersonal skills. Faculty reported that most of the feedback they received was about time management and patient care. Conclusions: This pilot study helped address a major barrier to improvement and growth within our training program and confirmed that feedback skills must be taught and practiced. A 6-hour virtual workshop showed tangible results in the satisfaction with and quality of feedback given to both fellows and faculty. Our findings are salient as we completed the intervention during the COVID pandemic. Limitations of the study include its single-institutional design and sample size. A major challenge anticipated is sustainability, which will be addressed by maintaining periodic lectures and assigning protected time for feedback.

The Effect of COVID‐19 on Medical Student Confidence

COVID-19 has spawned an age of mask-wearing and closure of many establishments. Words such as quarantine, “the practice of separating individuals who have had contact with someone with COVID,” and social distancing, the “practice of increasing the space between individuals to reduce the risk of spreading a disease,” have become normal in conversation. With 440,000 deaths in the US, cases continue to impact the global economy. Quarantining and social distancing may be the only way to prevent spread even with vaccine distribution. Included in the closures are medical schools. With one percent of Americans employed as physicians, the country entrusts few to maintain health for millions. In a profession with personal contact, the lack of in-person training may hinder the ability of physicians to achieve this goal. The purpose of this preliminary study was to examine current physicians-in-training, and their ability to diagnose and treat pathology while adapting to the distanced education due to COVID-19. Second-year students from two medical schools were surveyed with a questionnaire comprised of eight areas of suggestion to: assess confidence in pathology recognition on licensure examinations, confidence in pathology recognition in clinical settings, and the impact of COVID-19 on clinical competency skills. Results It was found that thirteen percent of students found online lectures to be very effective, with fifty-eight percent of students claiming moderate effective. Twenty-three percent of students share improved exam performance with online school, and seventy-seven percent of students had no change. Nearly ninety-two percent of students supplement coursework with other resources. Twenty-three percent of students feel very confident in their ability to recognize pathology on boards. Zero percent of students feel very confident in recognition in clinical settings. Over fifty percent of students feel their clinical competency skills have worsened. Students do not feel confident in their ability to care for a patient. Students do, however, feel confident for exams. Online education has shown to be effective in teaching nurses, and the same applies to medical school. With 70% of responses showing online lectures are effective, the conclusion is pathology can be taught without traditional means. Suggestions include condensation of material even further, proving students do not have issue with an online format. Total replacement for in-class learning does not seem applicable. While students have confidence in exam skills, confidence disappears when in a clinical setting. There is a difference between answering a clinical vignette and solving the presentation of a vignette in the clinic. More than 50% of students do not feel prepared clinically, showing that the online medical education is inadequate for teaching the basics of clinical duties, such as history and physical exam. With all of the current cohort lacking in-person training, those who do not feel prepared clinically may rise. Research has shown that COVID-19 may be the start of a change in medicine with advancements of telehealth; however, this is from the perspective of educators. The student shows low confidence for patient care due to the pandemic. Future studies will follow this cohort as they progress from online education to clinical rotation and beyond.

Effectiveness of Online Pathology Lecture in Medical School Students During the COVID‐19 Pandemic

PurposeThe COVID‐19 pandemic altered global humanity via economic and political challenges. It evoked a vigorous response in clinical medicine, as it required rapid development and delivery of COVID‐19 vaccines in less than a year (Le et al., 2020). Similarly, medical education also adapted with the same rate and intensity as its clinical counterparts.Infection control and mitigation measures evolved to limit viral spread. The CDC issued stay‐at‐home orders and directives to close non‐essential places. This included medical schools, which are considered high population density (CDC, 2021). Consequently, traditional in‐person didactics were compromised; educational delivery went to socially‐distanced online modes. Remote online‐learning of medical education includes video conferences for lectures, assessments of diagnostic and clinical skills via online modes, and virtual‐simulation use to aid problem‐based learning.Adaptive online‐learning for medical education boosts strong cooperation from faculty and students to meld curriculum to retain competency and accreditation requirements for students to graduate and become physicians. This study examines online lecture effectiveness during COVID‐19, specifically pathology, as medical students shift to optimize learning for board exam preparation and transition to clinical settings.MethodsIn this preliminary study, second year medical students at a US osteopathic medical school were anonymously surveyed in 2020‐2021 academic year. Target demographic was medical students required to use online learning due to COVID‐19; students had live, in‐person instruction in previous academic year, 2019‐2020, until the shift to online learning started March 2020. Data from survey included quantitative data on effectiveness of online learning versus in‐person lecture for medical students, impact of online learning on students’ foundational pathology preparation for board exams, and students' abilities to apply pathology knowledge with diagnostic reasoning in a clinical setting.Preliminary results show online learning of pathology in preparation for board exams elicited moderate confidence from 58% of second‐year medical students; a majority of students to report online learning as quite effective. Ninety‐two percent of students used external pathology resources (review books, video series, etc.) with online learning. However, more than half of students report low confidence in applying pathology knowledge in a clinical setting.DiscussionOverall, medical students showed moderate confidence in pathology board exam preparation via online learning. A study conducted by Mukhtar et al. (2020) supported online learning in medical schools due to increased student‐centered learning. Students using external board review resources found online learning provides efficient pathology curriculum management with time for board exam review during the pandemic.Most students reported low confidence in applying pathology knowledge in a clinical setting because online learning constraints include lack of integration of clinical pathology and clinical competency skills. Future studies will assess effectiveness of online learning with improved methods to implement pathology curriculum in clinical settings.

Expert consensus on Didactic Clinical Skills Development for orthodontic curricula.

Competence is expected of each beginning dentist and orthodontist. However, the broad definition of competence presents a challenge to academic programs in identifying the level of cognition for students to achieve competence. This study aimed to determine the Didactic Clinical Skills Development curriculum content and competency in predoctoral and advanced education orthodontic programs. A modified Delphi method with a consensus threshold of 70% was employed using an expert panel of academic orthodontists. Round One (n=26) identified that all topics proposed by a focus group were necessary, except for predoctoral Appliances, which was at 65%. Round Two (n=23) included subtopics of Appliances to confirm the lack of consensus, plus subtopics of all the other topics and the level of cognition required for each subtopic. The expert panel reached a consensus that all 24 subtopics, hence all topics, were necessary. In Round Three, subtopic responses in Round Two were assigned a value between 1 (remember) and 6 (create) to generate a hierarchical level-of-learning scale. Mean values were calculated for each subtopic response. For all subtopics, the mean level of cognition for predoctoral education was at understand; for advanced education, it was at evaluate. This consensus suggests that, to be deemed competent, beginning dentists must learn these topics and subtopics in the cognitive domain of understand, and beginning orthodontists in the cognitive domain of evaluate. This study showed an expert consensus on Didactic Clinical Skills Development orthodontic curriculum content and a panorama of educational objectives that could be used as a template for curriculum design.

Classic clinical descriptions of disease: curing medical education with a dose of the past

The importance of clinical skills, including obtaining patient history and performing physical examination, has been de-emphasized in the modern medical school curriculum. With advancements in diagnostic technologies, the clinical presentation of diseases in medical textbooks has been simplified, diminished, and largely replaced with detailed pathophysiology and laboratory findings. The implementation of the United States Medical Licensing Exam (USMLE) Step 1 has also contributed in pushing medical education toward classroom-based learning rather than emphasizing clinical experience. Clinical skills competency is crucial to accurately diagnose patients and simultaneously lowers health care costs by not relying on unneeded diagnostic tests. To address this gap in medical knowledge, a group of students at Texas Tech University Health Sciences Center, Lubbock, Texas, have created a website documenting classic clinical disease descriptions written by some of the renowned physicians from the 19th and 20th centuries, including Osler, Flint, Gowers, etc. This website will continue to grow and will be a useful tool for professors, physicians, and medical students.

Kinesthetic Learners During the COVID-19 Pandemic: Occupational Therapy Students’ Perspective on E-learning

The purpose of the study was to understand the perspective of kinesthetic learners in an online learning environment. A Microsoft Forms survey was created and distributed to the sample population using the university electronic mailing list. If self-identified as kinesthetic learners, subjects were asked to participate in a semi-structured focus group. Twenty-six subjects responded to the survey, with 73% (n=19) identifying as kinesthetic learners. Quantitative results showed subjects felt most confident in content comprehension but less confident in clinical application. Qualitative data collection led to emergence of the following four themes—advantages, disadvantages, accommodations to e-learning, and external factors. The study suggested kinesthetic learners’ decreased confidence in comprehension and acknowledged making accommodations for effective learning. Students reported instructional improvements to facilitate e-learning. They suggested instructors can show more concern for well-being and provide academic support for clinical skills competence.