History-taking Skills Research Articles

Developing a clinician-friendly rubric for assessing history-taking skills in medical undergraduates speaking English as a foreign language.

The Occupational English Test (OET) is a globally recognized test for healthcare professionals who speak English as a foreign language (EFL). Although its speaking sub-test criteria are publicly accessible, practical application demands specialized assessor training. The aim of the study was to create a physician-friendly rubric for assessing the English history-taking skills of EFL medical undergraduates inspired by the OET speaking sub-test. Informed by the OET criteria, a rubric was tailor-made to assess the English history-taking skills of EFL medical undergraduates studying in Japan. Using this rubric, 14 physicians assessed the English history-taking skills of 134 sixth-year medical undergraduates. We used exploratory factor analysis to ascertain its construct validity, evaluated the instrument's reliability through Cronbach's α and inter-rater reliability with chi-squared tests, and conducted a multiple regression analysis, ensuring adherence to key regression assumptions. Three key factors were found: linguistic-clinical distinction, communication dynamics, and medical comprehension. The rubric's internal consistency was verified, achieving a Cronbach's α of 0.799. Discrepancies in assessor scores highlighted the need for calibration. Four criteria emerged as vital in assessing the students' performance. The tailored rubric effectively assesses the English history-taking skills of EFL medical undergraduates.

Dual Coaching of Medical Clerkship Students' History-Taking Skills by Volunteer Inpatients at the Bedside and Faculty Physicians on Zoom during the COVID-19 Pandemic [Letter

Dual Coaching of Medical Clerkship Students' History-Taking Skills by Volunteer Inpatients at the Bedside and Faculty Physicians on Zoom during the COVID-19 Pandemic [Letter

Is Clinical Medicine Dying?

Recently, I came across a few discussions and write-ups on the dying art of clinical medicine caused by rapid advances in technology, which is replacing previously indispensable instruments such as stethoscope. Fred has interestingly termed it "Hyposkillia."1 Multiple editorials have decried the loss of clinical skills, and medical educators justify not only teaching but also using basic history-taking and physical examination skills in routine patient care.2-4 However, some skeptics suggest that emphasis on clinical skills is from a bygone era and that the availability of advanced imaging techniques and laboratory tests has supplanted ambiguous history and physical findings.5,6 Here is what I think.

Chronic pain patients’ evaluations of consultations: A matter of high expectations or expectations unmet?

ObjectiveThis study tests two hypotheses about spine pain patients’ expectations for consultations and their negative evaluations. High expectations may be impractical or unachievable and can set patients up for disappointment. Unmet expectations are the absolute difference between expectations before the visit and perceptions of expectations actually enacted. MethodWe conducted a single-site prospective study using pre- and post-consultation surveys. Patients (N = 200) were English-speaking individuals aged 18–75 presenting for an initial consultation for musculoskeletal pain. Analyses were conducted in SPSS v. 28.0 using mixed modeling to account for interdependence among cases. ResultsContrary to initial predictions, higher pre-consultation expectations for shared decision-making were positively linked to post-consultation satisfaction, trust, and agreement. Exceeding expectations in shared decision-making, history-taking, examination, and interpersonal skills significantly enhanced post-consultation outcomes. ConclusionsResults support the unmet expectations hypothesis over the high expectations hypothesis. Increased expectations and exceeding these expectations in key areas of patient-physician interaction were positively associated with improved consultation outcomes. Practice implicationsFindings highlight the importance of exceeding multifaceted patient expectations in physician evaluations. Yet, physicians must first understand the nature and source of each patient’s expectations pre-consultation, which vary across individuals in aspirational and realistic dimensions.

(071) IMPROVING TRAINEE COMFORT IN ASSESSMENT AND MANAGEMENT OF FEMALE SEXUAL HEALTH AND MENOPAUSE THROUGH AN INTERACTIVE WORKSHOP

Abstract Introduction Concerns related to female sexual health and menopause are common in clinical practice, but these topics are often inadequately covered during training. Many medical schools and residency programs lack a formal curriculum, and trainees in internal medicine, family medicine, and obstetrics and gynecology often graduate feeling uncertain in their management of these conditions. Objective Improve resident comfort with assessment and management of female sexual health and menopause through an interactive workshop. Methods We created a 90-minute, interactive workshop focused on female sexual health and menopause. Residents in internal medicine at a large academic medical center were invited to participate. A multidisciplinary group including physicians, advanced practice providers, registered nurses and a certified sex therapist were recruited to lead the workshop. Results Participants rotate through three 30-minute sessions targeted to learning objectives. One session focuses on conducting a symptom-based pelvic exam. A 3-dimensional model is used to review the anatomy of the female pelvic floor and demonstrate physical exam techniques to evaluate vaginal and vulvar symptoms, pelvic pain, and dyspareunia. Diagnostic skills include vulvar inspection to assess for skin and mucosal changes, cotton swab test of the vestibule, and assessment of pelvic floor musculature. A second session focuses on the genitourinary syndrome of menopause (GSM). The pathophysiology, presentation and treatment of GSM is introduced. Next, registered nurses with expertise in female sexual health and menopause lead an interactive demonstration of vaginal moisturizers and lubricants. Advice for counseling patients on the proper use and application of vaginal estrogens is also reviewed. The final session focuses on sexual health counseling, including sexual history-taking skills. Participants are taught about the domains of sexual function, female sexual response cycle, types of desire, patient resources, and sexual aids. Feedback following the initial iteration of this workshop was very positive. All participants felt that the experience was an effective use of time, would recommend it to others, and were confident in their ability to apply skills to their clinical practice. Conclusions This interactive workshop led by a multidisciplinary group of providers aims to improve trainee comfort in evaluation and management of female sexual health and menopause. Given the commonplace nature of these topics in primary care and paucity of existing curricula, consideration could be given to the inclusion of a similar educational experience into internal medicine, family medicine and/or obstetrics and gynecology residency programs. Disclosure No.

IJCM_196A: Exploring the transition from medical students to interns: A leap into clinical practice

Background: The transition from medical student to independent doctor is a crucial phase, marked by a year-long clinical internship in India. Despite this, challenges arise, and stress is common among interns. This study aims to assess the preparedness of interns graduating under the present MBBS curriculum in India and understand the challenges they face during their internship. Methodologyology: This cross-sectional analytical study was conducted in teaching hospitals affiliated with Kasturba Medical College, Mangalore. Interns working in various departments of these hospitals were included in the study. Universal sampling was employed, approaching all available interns during the 14-day study duration. The sampling strategy was non-random, based on convenient sampling. Results: Out of 150 interns, 77 scored well in various aspects of clinical skills. However, discrepancies were observed in specific areas. While 84% demonstrated good history-taking skills, only 55% could effectively discuss medications with patients. Interns displayed lower competence in understanding drug interactions, with only 37 out of 150 scoring well. Communication and teamwork were strong points, with 82 interns effectively working in a multi-disciplinary team. On the contrary, clinical procedures and diagnostic skills showed dismal performance, especially in emergency situations and practical procedures. Conclusion: Interns exhibit strength in communication and teamwork but face challenges in diagnostic skills and clinical procedures. The findings emphasize the need for targeted interventions in specific areas, ensuring a well-rounded preparation for junior doctors. Addressing these challenges will contribute to a smoother transition from medical students to competent healthcare professionals.

Developing a clinician-friendly rubric for assessing history-taking skills in medical undergraduates speaking English as a foreign language

Background The Occupational English Test (OET) is a globally recognized test for healthcare professionals who speak English as a foreign language (EFL). Although its speaking sub-test criteria are publicly accessible, effective application demands specialized assessor training. This study aimed to create a physician-friendly rubric for assessing the English history-taking skills of EFL medical undergraduates inspired by the OET speaking sub-test. Methods Informed by the OET criteria, a rubric was tailor-made to assess the English history-taking skills of EFL medical undergraduates studying in Japan. Using this rubric, 14 physicians assessed the English history-taking skills of 134 sixth-year medical undergraduates. The study used exploratory factor analysis to ascertain its construct validity, evaluated the instrument’s reliability through Cronbach’s α and inter-rater reliability with chi-squared tests, and conducted a multiple regression analysis, ensuring adherence to key regression assumptions. Results A total of three key factors were found: linguistic-clinical distinction, communication dynamics, and medical comprehension. The rubric’s internal consistency was verified, achieving a Cronbach’s α of 0.799. Discrepancies in assessor scores highlighted the need for calibration. In total, four criteria emerged as vital in assessing the students’ performance. Conclusions The tailored rubric effectively assesses the English history-taking skills of EFL medical undergraduates.

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.

Dual Coaching of Medical Clerkship Students' History Taking Skills by Volunteer Inpatients at the Bedside and Faculty Physicians on Zoom During the COVID-19 Pandemic.

Coaching is a well-described means of providing real-time, actionable feedback to learners. We aimed to determine whether dual coaching from faculty physicians and real inpatients led to an improvement in history-taking skills of clerkship medical students. Expert faculty physicians (on Zoom) directly observed 13 clerkship medical students as they obtained a history from 26 real, hospitalized inpatients (in person), after which students received immediate feedback from both the physician and the patient. De-identified audio-video recordings of all interviews were scored by independent judges using a previously validated clinical rating tool to assess for improvement in history-taking skills between the two interviews. Finally, all participants completed a survey with Likert scale questions and free-text prompts. Students' history-taking skills - specifically in the domains of communication, medical knowledge and professional conduct - on the validated rating tool, as evaluated by the independent judges, did not significantly improve between their first and second patient interviews. However, students rated the dual coaching as overwhelmingly positive (average score of 1.43, with 1 being Excellent and 5 being Poor), with many appreciating the specificity and timeliness of the feedback. Patients also rated the experience very highly (average score of 1.23, with 1 being Excellent and 5 being Poor), noting that they gained new insights into medical training. Students value receiving immediate and specific feedback and real patients enjoy participating in the feedback process. Dual physician-patient coaching is a unique way to incorporate more direct observation into undergraduate medical education curricula.

Should Virtual Objective Structured Clinical Examination (OSCE) Teaching Replace or Complement Face-to-Face Teaching in the Post-COVID-19 Educational Environment: An Evaluation of an Innovative National COVID-19 Teaching Programme.

Background The COVID-19 pandemic brought about drastic changes to medical education and examinations, with a shift to online lectures and webinars. Additionally, social restrictions in the United Kingdom (UK) inhibited students' ability to practice for objective structured clinical examination (OSCE) with their peers. Methods The Virtual OSCE buddy scheme (VOBS) provided a means to practice OSCE skills virtually by linking groups of 2-6 final-year medical students with a junior doctor who had recently passed their exams. Sessions were held virtually, tailored to the needs of each group, in a 3-month period prior to examinations. The scheme ran across two examination periods, 2020/21 and 2021/22, including a total of 13 universities throughout the UK. Results In 2020/21, 96% (n=227) of students described improved confidence in OSCE scenarios. Furthermore, 90% (n=213) reported improvement in communication, 89% (n=211) in diagnosis and clinical reasoning and 86% (n=203) in history-taking skills. Examination and procedural skills proved more challenging to practice virtually, with improvement reported by 31% (n=73) and 15% (n=36) of students, respectively. Ninety-three per cent (n=58) of buddies reported improved lesson planning abilities and 90% (n=57) felt more confident in their teaching. In 2021/22, 90% (n=133) of students felt more prepared for their OSCE. In key skills, improvement was reported by 87% (n=128) in communication, 84% (n=124) in diagnosis and clinical reasoning and 83% (n=123) in history-taking. In this cohort, 40% (n=59) reported improvement in examination skills and 24% (n=36) in procedural skills. Ninety per cent (n=83) of buddies reported an improvement in teaching skills, with 93% (n=85) increasing their confidence to teach. Conclusion VOBS demonstrates the benefits to students and teachers of near-peer OSCE teaching. Given the virtual nature, the main drawback is the inability to practice hands-on examination and procedural skills. This scheme provides insight to educators planning virtual teaching programmes in the future. With the evolution of technology, virtual examination and procedure practice may be possible in the near future. VOBS would suggest that currently, virtual OSCE teaching should be used to complement face-to-face teaching.

Differences in history-taking skills between male and female chiropractic student interns.

The purpose of this study was to determine if there was a difference in history-taking skills between male and female chiropractic student interns. This study included 2040 patient histories collected by student interns over a 3-year period. Students were assessed by chiropractic college clinicians on reasoning (ability to derive clinically relevant information using a mnemonic for taking a history), communication, and professionalism using a modified Dreyfus model scoring system on a 1-4 scale (1 = novice, 4 = proficient). Ordinal dependent variables were scores for reasoning, communication, and professionalism. The categorical independent variable was sex of the student intern (male or female). A Mann-Whitney U test was used to compare for differences in nonparametric dependent variables by the sex of the students. The Mann-Whitney U test revealed that communication scores were greater for female chiropractic interns compared with male chiropractic interns (p < .001, with a small effect size (r = -.08). There was no statistically significant effect for sex on reasoning (p = .263) or professionalism (p = .098). Female chiropractic student interns scored higher than male interns on communication skills during a history-taking patient encounter. This supports the trend seen among female medical school students and physicians that women score higher than men on communication-related assessments.

Enhancing History-Taking Skills in Medical Students: A Practical Guide.

History-taking skills are an essential part of the medical school curriculum. However, from the author's experience and available literature, students consistently report a lack of confidence in their history-taking abilities, and as a result, feel underprepared for upcoming summative communication skills assessments. Therefore, as medical students at the University of Cambridge, we used evidence-based education to create a history-taking teaching programme that aimed to increase confidence and preparedness for communication skills exams. This article outlines 12 tips to be used when teaching history-taking skills to medical students. These tips were created using student feedback, personal experience, and wider literature on the topic. Creating and teaching an effective history-taking course can take significant effort and time. However, we hope this guide provides a starting framework that can be quickly applied to allow users to create effective history-taking skills courses for their students.

Integrating Narrative Medicine Through Story-Telling: A Feasibility Study in a Community Medicine Curriculum for Undergraduate and Postgraduate Students.

Introduction The routine curriculum of community medicine includes clinico-social case-taking with a focus on the physical, biological, and psychosocial determinants of health. There is an opportunity to integrate narrative medicine with this for undergraduate and postgraduate medical students using story-telling. The objective of the current study was to assess its feasibility, challenges, and opportunities. Methods We conducted a need assessment cross-sectional survey of the teaching faculty of community medicine across India using Google Forms. Considering an 80% positive response in a pilot within the department, a relative error of 10%, and a 20% non-response rate, the sample size was 120. The questionnaire included closed-ended questions with a Likert scale that dealt with affective, cognitive, and communication domains and open-ended questions for insights into opportunities and challenges. The results of the former were expressed as descriptive statistics, in frequencies and proportions. Open-ended questions were summarized to guide the refinement of further implementation. Results Of the 120 participants, 92 (77%) quoted low/medium empathy quotient in students, and 107 (89.2%) felt that the listening skills of students can improve with the introduction of story-telling. A hundred and twelve (93.4%) participants felt that their history-taking skills can improve with story-telling, and all agreed that the language of medicine can be improved. One hundred nine (90.8%) felt that it will lead to better student-patient interaction. Opportunities included a better understanding of social determinants, patient-/family-centered care, improved communication skills, and better mental health. The key challenges included time, motivation, the need for training/capacity building, and streamlining of assessment metrics. Conclusion We conclude that story-telling may help medical students investigate various social determinants of health, disease, and lived environments that createvulnerabilities.

Vaginal Bleeding In Prepubertal Girls-A Case Series in Malaysia

The etiology of prepubertal vaginal bleeding varies from isolated pubertal causes to malignant tumors and generates significant anxiety among girls and their caretakers. Hence, these cases require careful assessment and management. This is a report of five cases of prepubertal vaginal bleeding with various causes and were managed in a tertiary referral center in Malaysia. The first case was a 6-year-old girl who had no pubertal changes with 3 weeks’ history of bleeding. She underwent examination under anesthesia and found to have multiple vaginal polyps. Another 6-year-old girl noted to have a doughnut-shaped mass protruding from her urethral meatus. She was treated with estrogen cream and sitz baths. Another child had early breast development while pelvic ultrasound revealed a multiseptated ovarian cyst requiring a cystectomy. A 19-month-old toddler had a large intravaginal mass. She required further investigation, referral to the pediatric surgeon and oncologist for treatment of a malignant yolk sac tumor. Lastly, an 8-year-old girl was noted to have monthly vaginal spotting without any secondary sexual characteristics development. Prepubertal vaginal bleeding is abnormal thus requires prompt assessment to ascertain the cause and administer appropriate management. It is important to rule out sexual abuse and malignancy. Examination under anaesthesia and vaginoscopy is recommended when imaging modality is inconclusive. Referral to tertiary centres experienced in managing such cases ensures good outcomes. Thorough targeted history-taking and pediatric-specific gynecological examination skills are crucial to formulate accurate diagnosis and appropriate management.

Evaluating the History-Taking Process of Sexual Reproductive Health Problems in Tanzania: Lessons from a Study of Health Students and Practitioners.

Building trust and therapeutic relationships between healthcare providers and patients are crucial for delivering high-quality, comprehensive sexual and reproductive health (SRH) services. Yet, while patients face substantial SRH disparities in Tanzania, little is known about health care professionals' [HCPs] SRH history-taking practices and experiences. This paper describes HCPs' interdisciplinary practices, experience in conducting SRH taking, and the critical lessons learned to optimize quality SRH care. We conducted 18 focus group discussions in June 2019 in Dar es Salaam, Tanzania, with 60 healthcare practitioners and 61 students in midwifery, nursing, and medicine. We implemented a purposive, stratified sampling design to explore the experiences and perspectives of HCPs regarding providing sexual health services. We employed a grounded theory approach to perform the analysis. We provided seven scenarios to participants to discuss how they would manage SRH health problems. The scenarios helped us evaluate the practice and experience of SRH in Tanzania. Four broad themes and sub-themes emerged during the discussion; 1) SRH history-taking practices and experiences in the health care facilities; 2) the perceived benefit of effective SRH history-taking; 3) Factors hindering the SRH history-taking process; 4) The power of confidence. These findings have implications for strengthening a sexual health curriculum for medical students and continuing education programs for practicing health professionals designed to address the observed health disparities in Tanzania. These findings affirm that proper SRH history-taking requires a conducive environment, knowledge of relevant SRH-related laws and regulations; application of evidence-based techniques; and giving patients autonomy to make decisions for their health while making recommendations regarding standard care. Comprehensive SRH history-taking identifies critical data for illness diagnosis, provides foundational information for risk-reduction behavioural change counselling, and reduces medical costs. Therefore, the primary goal is to optimize health professional training on SRH issues and history-taking skills within the medical interview.

Implementation and Assessment of A Pilot Workshop on Inpatient First Time Seizure History Taking and Counseling (P14-2.002)

<h3>Objective:</h3> To implement an intervention aimed at improving neurology residents’ history-taking and counseling skills when consulted for a “first-time seizure.” This intervention comprises three interactive, practice-based workshops implemented by a chief resident and epileptologist. <h3>Background:</h3> Neurology residents at our institution are frequently consulted for “first-time seizures,” but lack structured training. A structured workshop was planned to provide instruction and real-time feedback. <h3>Design/Methods:</h3> Four interactive cases were prepared with the brief: “You are consulted by the emergency department overnight for a ‘first-time seizure.’” The chief resident and eplileptologist acted as standardized patients; participants obtained a history and formulated a preliminary diagnosis. The history-taking goals were to 1) distinguish epileptic seizures from seizure mimics; 2) distinguish unprovoked, provoked, and acute symptomatic seizures; 3) to identify underlying epilepsy. Residents then provided counseling, including 1) the diagnosis, 2) diagnostic testing, 3) treatment, 4) driving and seizure precautions, and 5) gender-specific considerations as appropriate. Residents were presented with a 5-question pre- and post-quiz to assess their knowledge and a 5-question survey to assess their subjective confidence before and after the intervention. <h3>Results:</h3> Of eight residents who participated in the workshop, seven responded to the surveys. Subjectively, 5 (71%) reporting improved confidence in history taking and 6 (86%) reporting improved confidence in counseling. However, we did not see an objective change in the quiz results (pre: 71%–100%, post: 71%–100%). <h3>Conclusions:</h3> While the residents performed well on the knowledge-based quiz, this intervention was still able to improve participants’ confidence in their history-taking and counseling skills. This finding reflects the complexity of the topic and the need for ongoing training among residents. <b>Disclosure:</b> Dr. Rehim has nothing to disclose. Dr. Zobel has nothing to disclose. Dr. Husain has a non-compensated relationship as a member, Medical Board of Directors with Epilepsy Foundation of Eastern Pennsylvania that is relevant to AAN interests or activities.

Assessing the Impact of Standardized Patient Encounters on Students’ Medical History-taking Skills in Practice

Objective. To investigate whether exposing students to professional standardized patients (SPs) in a didactic course would impact the transferability of students' medical history-taking skills to practice.Methods. In 2018, peer role-play and virtual simulation activities were used to teach medical history-taking in a first-year physical assessment and medication administration course. An unannounced SP evaluated students' medical history-taking skills during a subsequent community introductory pharmacy practice experience (IPPE) using a 17-item medical history checklist. In 2019, 3 SP encounters were added to the course to supplement existing learning activities. This student cohort was then assessed by the same unannounced SP during their IPPE in summer 2019. Medical history-taking performance was compared with the 2018 control group to assess the impact of the changes to the course.Results. Thirty-nine students in both the summer 2018 and 2019 cohorts had usable data. There was a statistically significant increase in the 2019 mean composite score on the medical history checklist (24.3 vs 18.1). The 2019 cohort performed significantly better than the 2018 cohort in 7 of the 17 items on the checklist. The correlation between students' performance on the summative medical history-taking assessment during the course and their performance in practice was r=.15 in 2018 and r=.08 in 2019.Conclusion. Incorporating SPs into a physical assessment and medication administration course contributed to an improvement in students' ability to take a medical history in practice as compared with solely using a virtual patient simulation program.

A clinical medicine level test at Jinan University School of Medicine reveals the importance of training medical students in clinical history-taking.

Training in the basic interview skills of clinical history-taking has always been a significant component of medical education. This study was designed to identify the factors influence medical students' history-taking skills learning and develop a way to improve these skills. We firstly analysed the academic performance of medical students at Jinan University School of Medicine in different disciplines of the Clinical Medicine Level Test (CMLT), to ensure the students have obtained comprehensive medical education prior to beginning their clinical internships. Next, we conducted a survey among the CMLT participants to seek the underlying causes and corresponding measures to improve history-taking in the future. Before these medical students entered their fifth-year clinical practice, we finally provide them with pre-internship training, including the history-taking workshops with standard patients (SP). The analysis of the clinical skill sections of the CMLT revealed that the students performed significantly better on clinical operations from multiple disciplines than on medical history-taking. Principal component analysis of the survey questionnaire indicated that the capability of history-taking, course assessments, and awareness of the value of medical history-taking emerged as the key factors forming a cohesive clue for sustaining history-taking implementation. The intervention workshops of employing SP had a positive impact, as evidenced by the students' feedback and suggestions for improving their ability of history-taking. This study suggests that strengthening of medical history-taking training is indispensable for training qualified medical students. Workshops with SP is a successful teaching strategy for practicing history-taking, allowing students to spot minute errors and training communication skills.

Comparing the Perceptions of Reciprocal- and Near-Peer Objective Structured Clinical Examinations (OSCEs) in Medical Students.

The Objective Structured Clinical Examination (OSCE) is utilized by medical schools to assess students' competency in clinical skills. Literature has shown that first-year students who were tutored by fourth-year students (MS4s; near-peer) in practice OSCEs reported self-perceived improvement in OSCE skills. There is a lack of research regarding the effectiveness of first-year (MS1) pairs for reciprocal-peer practice OSCEs. This study aims to assess if virtual reciprocal-peer OSCEs provide comparable learning opportunities to virtual near-peer OSCEs. MS1 students were assigned to work with a near-peer or a reciprocal-peer for one week, and then switched protocols the second week. One student in each reciprocal-peer pair was assigned to act as a standardized patient (SP). Their partner took a history, interpreted physical exam findings, prepared a note, and gave an oral presentation. The pair then switched roles using a second case. The near-peer group followed the same procedure, without the reversal of roles. A total of 135 MS1s participated in the first week and 129 in the second week.Students agreed that working with a near-peer was more valuable than a reciprocal-peer in the following parameters: peer feedback (N=113, 89%), history-taking skills (N=101, 80%), physical exam skills (N=102, 81%), and note-writing skills (N=109, 89%). Pairwise comparison utilizing Wilcoxon signed-rank test indicated participants preferred the choice of a fourth-year student partnerover an MS1 partner (Z=1.436, p<0.001). Participants found working with a near-peer increased confidence in their clinical skills and near-peer feedback was more valuable. Although MS1s found that watching and evaluating their peers in a reciprocal-peer exercise was beneficial, students overwhelmingly preferred working with MS4s due to more valuable feedback.

Master clinical teachers and personalised learning.

Clinical history taking and physical examination are two of the most important competencies of physicians. In addition to informing diagnoses, these activities build rapport and establish relationships between caregivers and patients. Despite this, emphasis on the assessment of bedside clinical skills is declining. To prepare our students for clinical work, we began a clinical competency, personalised teaching programme in which students perform a history and physical examination in front of a master clinical teacher (MCT) approximately every 2 weeks throughout their core clerkship year. The MCT works with the student in a clinical encounter, providing personalised bedside instruction on all features of being a clinician including bedside manner, history-taking skills, physical examination skills, and clinical reasoning. The MCT then provides an assessment of student's competency development and gives feedback to the student about what they do well and where they have opportunities for growth. Assessment data are collected and tracked longitudinally across the clerkship phase to ensure that each student is progressing developmentally. With over 6000 observations of student performance, we are able to discern competency development and growth over time. We can identify if a student is not improving as expected during their clerkship phase and intervene by providing extra practice and training. This core clerkship teaching programme has been well received by both students and instructors and has led us to pilot this approach during the post-clerkship phase of our medical training.