Examination Skills Of Medical Students Research Articles

Revolutionizing Critical Care Training with Simulation-Based Education

One key principle in healthcare education involves creating teaching and assessment methods that enable instructors to evaluate a trainee’s performance in scenarios mirroring real clinical practice. Standardized patients (SPs) have frequently been employed to evaluate the history-taking and physical examination skills of medical students and practicing physicians.1 Unfortunately, in critical care settings, training and skill development involving real-time patients and situations come with inherent risks and may give rise to numerous ethical concerns. Particularly in the realm of critical care, where rapid decision-making and precise skills are often the difference between life and death, the demand for effective training methods has grown exponentially. While traditional approaches have their merits, there’s a paradigm shift taking place in healthcare education, with simulation-based training emerging as a powerful tool for nurturing the next generation of critical care specialists.2 Simulation-based training in critical care represents a profound leap forward in the way we prepare healthcare professionals for real-world challenges. It’s not just a trend; it’s a revolution, one that’s enhancing the knowledge and skill set of medical personnel and, most importantly, improving patient outcomes. This editorial aims to shed light on the transformative potential of simulation-based training in critical care and its many advantages.

Self-Assessment Video: An Effective Supplementary Learning Tool in the Development of Cardiovascular Examination Skills of Medical Students

Background: Self-evaluation can augment the facilitation of acquiring knowledge, skills and attitude through a reflective method. Self-assessment video (SAV) can be a very useful reflective method tool that is student-centered and self-directed. Objective: This study aimed to identify if SAV is an effective supplementary learning tool in improving cardiovascular examination knowledge, skills and attitude of second year medical students. Methodology: A quasi-experimental two-group design with pre- and post-test was used. The study population by convenience sampling involved second year medical students of the University of Santo Tomas Faculty of Medicine and Surgery. A structured direct observation checklist on cardiovascular precordial examination was used, done on two occasions in a week interval period. The said examinations were recorded in a video and evaluated and scored by two independent facilitators on these two occasions. The experimental group had the opportunity to review their videos immediately after the two examinations and accomplished self-assessment form. One-Way Repeated Measures Multivariate Analysis of Variance (One-Way RM-MANOVA), a parametric multivariate test for between- and within-group comparison of multiple dependent variables was used. Results: It showed that there was a significant improvement in all parameters measured after the intervention (SAV in the experimental group compared to the control group). Conclusion: The study showed that SAV is an effective supplementary learning tool in cardiovascular examination attitude, knowledge, and skills, and can be a very useful teaching and learning self-evaluation tool. Key words: Self-Assessment Video, Reflective Learning, Self-Directed Learning, Learning Tools, Evaluation Tools.

The influence of gender on clinical examination skills of medical students in Jordan: a cross-sectional study

BackgroundA graduating medical doctor is expected to be competent in physical examinations across all systems. The exploration of how gender affects the development of clinical skills has not been explored in an Arab context, despite cultural restrictions that make it more difficult for students and doctors to examine the opposite sex.MethodsA cross sectional survey was undertaken of graduating final year medical students in Northern Jordan. We asked about students’ perceptions regarding factors that may impact the development of clinical skills potentially related to gender, and asked about the frequency of examinations performed during their training for intimate and general physical examinations on all patients, as well as patients of the opposite sex. We also asked about the students’ confidence in performing the examinations (3-point Likert-scale). Comparison of male and female proportions was done using Chi square tests analysis.ResultsOne hundred eighty-eight final year students from 481 students (41%) completed the survey, 99 males and 89 females. The greatest factor given for impacting a student’s clinical examination of a patient of the opposite sex was cultural or religious traditions. Overall male students perform more clinical examinations than female students, with the odds of a male conducting more than 10 cardiovascular examinations on any patient compared to female students being 2.07 (1.13–3.79) and as high as 3.06 (1.53–6.18) for thyroid examinations. However, females were significantly more likely to examine male patients than vice versa (0.49 (0.27–0.88) for cardiovascular and 0.39 (0.21–0.71) for respiratory examinations). The gender division was more prominent for intimate examinations, with a lower odds of males conducting breast 0.11 (0.04–0.28) and vaginal examinations 0.22 (0.02–1.98) and more male students conducting prostate examinations OR 11.00 (1.39–87.03) and male genitalia examinations OR 16.31 (3.75–70.94). Overall a large proportion of students had never performed common intimate clinical examinations at all.ConclusionsIn our context, clinical exposure to both intimate and general clinical examinations differs significantly between male and female students. A greater awareness and more research on the influence of gender on clinical skill attainment in conservative cultures is needed with appropriate adaption of clinical teaching.Trial registrationNon interventional thus not required.

Development of an innovative physical examination course involving handheld ultrasound devices.

This article was migrated. The article was marked as recommended. Several studies in recent years have shown that the physical examination skills of medical students are inadequate. In response to this deficit, a new teaching intervention has been developed consisting of five physical examination courses and a set of corresponding bedside teaching modules. The bedside modules are primarily intended to provide the opportunity for practical application of the examination techniques learned. One particularity of the bedside teaching was the use of handheld ultrasound (HHU) units in order to be able to visualize and verify/falsify diagnostic findings immediately. Since this demonstration of findings was standardized according to the specifications of the Rapid Ultrasound in Shock and Hypotension (RUSH) protocol, it constituted the basis for the communication of basic emergency ultrasound skills. A pilot study, which included an initial evaluation, has demonstrated this concept is feasible and is met with great interest on the part of the students.

L’enseignement par discipline de la sémiologie en deuxième année de médecine améliore l’acquisition des compétences. Exemple de la sémiologie neurologique

IntroductionSince 2014–2015, practical teaching of clinical observation skills for 2nd year medical students at our faculty has been discipline-based; previously, each clinical lecturer had to cover all medical fields. We assessed the impact of this teaching reform on the neurological examination skills of medical students in a before-and-after study. MethodsPre-reform 3rd and post-reform 2nd and 3rd year medical students (n=62, n=71 and 52, respectively) had to perform 7 neurological examination items, for which performance criteria had been pre-defined. Subsequently, we assessed whether the mean grade in neurological examination skills during the test at the end of the 2nd year was different between students who had received neurological teaching from a neurologist (n=29) or another specialist (n=102). ResultsThe median [interquartile range] number of items acquired by post-reform 3rd year students (4 [2–5]) was higher than that of pre-reform 3rd year students (2 [1–3]; P<0.001), but lower than that of post-reform 2nd year students (5 [4–6]; P=0.01). The mean grade obtained during the practical test was not different in students trained by a neurologist or another specialist. ConclusionAcquisition of neurological examination skills improved after the teaching reform which consisted of: (1) a discipline-based practical teaching of clinical observation skills; (2) a training of clinical lecturers to teach a limited list of educational objectives; and (3) the introduction of a practical test at the end of the 2nd year of medical studies. However, there was a decline in clinical observation skills between 2nd and 3rd year medical students.

Development of an innovative physical examination course involving handheld ultrasound devices

This article was migrated. The article was not marked as recommended. Several studies in recent years have shown that the physical examination skills of medical students are inadequate. In response to this deficit, a new teaching intervention has been developed consisting of five physical examination courses and a set of corresponding bedside teaching modules. The bedside modules are primarily intended to provide the opportunity for practical application of the examination techniques learned. One particularity of the bedside teaching was the use of handheld ultrasound (HHU) units in order to be able to visualize and verify/falsify diagnostic findings immediately. Since this demonstration of findings was standardized according to the specifications of the Rapid Ultrasound in Shock and Hypotension (RUSH) protocol, it constituted the basis for the communication of basic emergency ultrasound skills. A pilot study, which included an initial evaluation, has demonstrated this concept is feasible and is met with great interest on the part of the students.

Effects of ultrasound implementation on physical examination learning and teaching during the first year of medical education.

Increasing emphasis has been placed on point-of-care ultrasound in medical school. The overall effects of ultrasound curriculum implementation on the traditional physical examination skills of medical students are still unknown. We studied the effects on the Objective Standardized Clinical Examination (OSCE) scores of year 1 medical students before and after ultrasound curriculum implementation. An ultrasound curriculum was incorporated into the physical diagnosis course for year 1 medical students in the 2012-2013 academic year. We performed a prospective observational study comparing traditional OSCE scores of year 1 medical students exposed to the ultrasound curriculum (post-ultrasound) versus historic year 1 medical student controls (pre-ultrasound) with no ultrasound exposure. Questionnaire data were also obtained from year 1 medical students and physical diagnosis faculty to assess attitudes toward ultrasound implementation. The final overall OSCE scores were graded with a 5-point Likert-type scale from unsatisfactory to outstanding. There was a significant increase in outstanding scores in the post-ultrasound compared to the pre-ultrasound group (27.0% versus 10.9%; P< .001). The post-ultrasound group had significantly (P< .05) increased first-time pass rates on blood pressure measurements, the abdominal examination, and professionalism. Student and physical diagnosis faculty questionnaire data showed an overall positive response, with most agreeing or strongly agreeing that ultrasound should be included in the future year 1 medical student curriculum. Ultrasound implementation into a physical diagnosis curriculum for year 1 medical students is feasible and may improve their overall traditional physical examination skills.

Can near-peer medical students effectively teach a new curriculum in physical examination?

BackgroundStudents in German medical schools frequently complain that the subject ‘clinical examination’ is not taught in a satisfying manner due to time constraints and lack of personnel resources. While the effectiveness and efficiency of practice-oriented teaching in small groups using near-peer teaching has been shown, it is rarely used in German medical schools. We investigated whether adding a new near-peer teaching course developed with student input plus patient examination under supervision in small groups improves basic clinical examination skills in third year medical students compared to a traditional clinical examination course alone.MethodsThird year medical students registered for the mandatory curricular clinical examination course at the medical faculty of the Technische Universität München were invited to participate in a randomised trial with blinded outcome assessment. Students were randomised to the control group participating in the established curricular physical examination course or to the intervention group, which received additional near-peer teaching for the same content. The learning success was verified by a voluntary objective structured clinical examination (OSCE).ResultsA total of 84 students were randomised and 53 (63%) participated in the final OSCE. Students in the control group scored a median of 57% (25th percentile 47%, 75th percentile 61%) of the maximum possible total points of the OSCE compared to 77% (73%, 80%; p < 0.001) for students in the intervention group. Only two students in the intervention group received a lower score than the best student in the control group.ConclusionAdding a near-peer teaching course to the routine course significantly improved the clinical examination skills of medical students in an efficient manner in the context of a resource-constrained setting.

A randomised controlled trial of blended learning to improve the newborn examination skills of medical students

ObjectiveTo evaluate the hypotheses that a blended learning approach would improve the newborn examination skills of medical students and yield a higher level of satisfaction with learning newborn examination.MethodUndergraduate medical...

Exploring the use of videotaped objective structured clinical examination in the assessment of joint examination skills of medical students

Objective structured clinical examination (OSCE) is a key part of medical student assessment. Currently, assessment is performed by medical examiners in situ. Our objective was to determine whether assessment by videotaped OSCE is as reliable as live OSCE assessment. Participants were 95 undergraduate medical students attending their musculoskeletal week at Freeman Hospital, Newcastle (UK). Student performance on OSCE stations for shoulder or knee examinations was assessed by experienced rheumatologists. The stations were also videotaped and scored by a rheumatologist independently. The examinations consisted of a 14-item checklist and a global rating scale (GRS). Mean values for the shoulder OSCE checklist were 17.9 by live assessment and 17.4 by video (n = 50), and 20.9 and 20.0 for live and video knee assessment, respectively (n = 45). Intraclass correlation coefficients for shoulder and knee checklists were 0.55 and 0.58, respectively, indicating moderate reliability between live and video scores for the OSCE checklists. GRS scores were less reliable than checklist scores. There was 84% agreement in the classification of examination grades between live and video checklist scores for the shoulder and 87% agreement for the knee (kappa = 0.43 and 0.51, respectively; P < 0.001). Video OSCE has the potential to be reliable and offers some advantages over live OSCE including more efficient use of examiners' time, increased fairness, and better monitoring of standards across various schools/sites. However, further work is needed to support our findings and to implement and evaluate the quality assurance issues identified in this work before justifiable recommendations can be made.

Impact of a 1-Day Ophthalmology Experience on Medical Students

To improve the ophthalmic knowledge and eye examination skills of third-year medical students through the development and implementation of a 1-day ophthalmology experience. Noncomparative interventional case series. One hundred twenty-one third-year medical students at the Penn State College of Medicine completed the 1-day ophthalmology experience. A 1-day ophthalmology curriculum, based on the Association of University Professors in Ophthalmology Policy Statement on Medical Student Education, was developed and implemented. The 1-day program consisted of a morning conference series and an afternoon case-based learning and eye examination skills session. The students completed a questionnaire to assess the impact of the experience on their ophthalmology knowledge and skills. In addition, the students completed a pretest and posttest to measure the impact of the 1-day ophthalmology experience on their ophthalmic knowledge. The 1-day ophthalmology experience was effective in improving the ophthalmic knowledge and eye examination skills of medical students based on the results of questionnaires, multiple choice examinations, and skills assessment. There was a statistically significant increase in test score percentage after the 1-day ophthalmology experience: the mean score on the pretest was 55%, compared with a mean score of 80% on the posttest. The ophthalmology-in-a-day experience is an effective way to improve the ophthalmic knowledge and eye examination skills of medical students.

Assessing the head-to-toe physical examination skills of medical students

Second-year medical students performed a head-to-toe screening physical examination on trained patient instructors (PIs) as a high-stakes examination before beginning clinical clerkships. PIs completed a 138-item checklist and instructed the students in the proper performance of any incorrectly executed or omitted items. To assess the accuracy of the PI ratings, 'monitor' PIs watching the encounter by video completed checklists for 11 retests of failed students in 2001 and for 28 randomly selected encounters in 2002. Checklist-level discrepancies measured by mean absolute checklist difference were 8% in 2001 and 9% in 2002. Case-level mean difference between raters in 2002 was -2.9%. The inter-rater reliability for a single rater, estimated by the intra-class correlation coefficient for total encounter scores, was 0.95. The assessment and feedback were well received by the students. The Head-to-Toe examination provides a reliable assessment of a student's ability to carry out a complete screening physical examination. Patient instructors can be trained to acceptable accuracy and reliability despite the length and complexity of the exercise, and can provide effective feedback and teaching targeted to individual student deficiencies.

Positive impact of an intervention by arthritis educators on retention of information, confidence, and examination skills of medical students

To determine whether an intervention by trained persons with arthritis could have a positive impact on retention of information, confidence, and examination skills of medical students. Second-year medical students were introduced to the musculoskeletal examination as part of their Introduction to Clinical Medicine course by viewing a video (n = 93) or were taught the joint examination by a trained arthritis educator after viewing the video (n = 88). Each group was tested before and after the intervention about arthritis information, confidence, and attitude about arthritis and also evaluated for the ability to carry out a musculoskeletal examination. Retention of information and confidence of both groups increased as a result of the intervention. However, students who received the arthritis educator intervention increased their scores significantly in comparison. Musculoskeletal examination skills of the students receiving the arthritis educator intervention were also significantly greater than the control group. An intervention by arthritis educators improved the retention of information, confidence, and examination skills of second-year medical students significantly compared with the standard educational approach. The impact of the intervention persisted for at least two weeks.

A model for evaluating the history taking and physical examination skills of medical students.

As indicated by George Engel (1982) the instructor being present while a student takes a history and performs a physical examination has been notoriously lacking in the clinical years of a medical student's education. Similarly in the pre-clinical Introduction to Clinical Medicine courses when basic instruction in these skills are taught, the incompatibilities of the instructor's and student's schedules make review with the instructor difficult. These incompatibilities make valid assessment of the student's skills difficult and feedback to the student almost non-existent. This study demonstrates the use of simultaneous recorded running commentary to enhance videotape as a means of providing meaningful feedback to the student that aids learning and a valid means of assessing the skills of the student.

Life Is Short, the Art Long, Opportunity Fleeting, Experience Treacherous, Judgment Difficult

To the Editor. —We read the article in the Dec 18, 1987, issue of JAMA by Drs Elliot and Hickam 1 with great interest. We were pleased to see the topic of the consistency of patient instructors (we now call them standardized patients ) compared with faculty observers appear inTHE JOURNAL. To provide a valid and reliable method for evaluating physical examination skills of medical students is one of the challenges facing medical education today. We have trained patient instructors to teach and evaluate physical diagnosis skills for more than 15 years. 2-4 They have been used extensively throughout the undergraduate curriculum, as well as for residents and practitioners. Our experience with the use of patient instructors has been even more encouraging than that reported by Drs Elliot and Hickam. For example, we have used patient instructors as a quality control check of the skills of students in physical diagnosis

Impact of several variables on physical examination skills of medical students.

Impact of several variables on physical examination skills of medical students.