Objective Structured Clinical Examination Scores Research Articles

Immunization Simulation Using Actual-Size Infant Manikins for Medical Students in Indonesia

Introduction Manikins are tools used in simulation training for medical students to develop important skills, one of which is immunization. However, conventional manikins often do not resemble the actual size of an infant's arm or leg. This study aimed to determine the impact of using actual-size manikins on students' knowledge and practical skills, evaluate their confidence in immunization practice, and assess students' responses and feedback regarding the practice using actual-size manikins. Methods This was a quasi-experimental study involving medical students at the Faculty of Medicine, Universitas Indonesia, from October 2020 to April 2021. Students in the intervention group used newly developed actual-size infant arm and leg manikins, while the control group used conventional manikins. All students underwent the objective structured clinical examination (OSCE) and the scores were compared between the 2 groups. Within the intervention group, data on pretest and posttest scores, feedback questionnaires, and self-confidence assessments were also obtained and analyzed. Results A total of 205 students were included. Statistically significant difference was found in the OSCE scores between the intervention and control groups (P < 0.01). Students in the intervention group (n = 108) showed significant improvement in knowledge scores after the workshop (P < 0.01). Most students (81.7%) expressed confidence in administering vaccines to live patients after practicing with manikins. In addition, 98.2% of students (n = 107) acknowledged the benefits of practicing with actual-size manikins in accurately determining the injection sites. Conclusions Simulation with the actual-size manikins significantly improved students' knowledge and practical immunization skills, leading to increased confidence and competence in their immunization skills.

Developing an Educational Program for Ultrasound Hip Screening during Newborn and Infant Home Visits: A Protocol Paper.

Ultrasound hip screening is suitable for the early identification of developmental dysplasia of the hip (DDH). Newborn and infant home visits are good opportunities for hip screening in the community, but studies focusing on nurse-led screenings are lacking. Based on a pre-post design, this study aims to develop and evaluate an ultrasound training program to improve nurses' assessment skills in detecting DDH cases during newborn and infant home visits. Said educational program will include e-learning, hands-on seminars, and clinical training. The primary outcome will be the success rate of imaging standard planes (standardized images for hip assessment) in clinical training. The secondary outcomes will include knowledge test results, objective structured clinical examination scores, time required for imaging, and inter-rater reliability between nurses and physicians. The educational program will address the issue of missed and late detection of DDH cases in resource-limited communities. This study will demonstrate the feasibility of procedures and the effectiveness of the educational program in 2024. The protocol was registered in the University Hospital Medical Information Network Clinical Trial Registry before starting the study (no. UMIN000051929, 16 August 2023).

Exam prediction and the general Practice Registrar Competency Assessment Grid (GPR-CAG)

ABSTRACT Background In GP training, identifying early predictors of poor summative examination performance can be challenging. We aimed to establish whether external clinical teaching visit (ECTV) performance, measured using a validated instrument (GP Registrar Competency Assessment Grid, GPR-CAG) is predictive of Royal Australian College of General Practitioners (RACGP) Fellowship examination performance. Methods A retrospective cohort study including GP registrars in New South Wales/Australian Capital Territory with ECTV data recorded during their first training term (GPT1), between 2014 and 2018, who attempted at least one Fellowship examination. Independent variables of interest included the four GPR-CAG factors assessed in GPT1 (‘patient-centredness/caring’, ‘formulating hypotheses/management plans’, ‘professional responsibilities’, ‘physical examination skills’). Outcomes of interest included individual scores of the three summative examinations (Applied Knowledge Test (AKT); Key Feature Problem (KFP); and the Objective Structured Clinical Examination (OSCE)) and overall Pass/Fail status. Univariable and multivariable regression analyses were performed. Results Univariably, there were statistically significant associations (p < 0.01) between all four GPR-CAG factors and all four summative examination outcomes, except for ‘formulating hypotheses/management plans’ and OSCE score (p = 0.07). On multivariable analysis, each factor was significantly associated (p < 0.05) with at least one exam outcome, and ‘physical examination skills’ was significantly associated (p < 0.05) with all four exam outcomes. Discussion ECTV performance, via GPR-CAG scores, is predictive of RACGP Fellowship exam performance. The univariable findings highlight the pragmatic utility of ECTVs in flagging registrars who are at-risk of poor exam performance, facilitating early intervention. The multivariable associations of GPR-CAG scores and examination performance suggest that these scores provide predictive ability beyond that of other known predictors.

Virtual Clinical Simulation for Training Amongst Undergraduate Medical Students: A Pilot Randomised Trial (VIRTUE-Pilot).

Clinical virtual simulators are promising new technologies that might facilitate teaching clinical skills. This study aimed to assess whether a virtual reality simulator might facilitate learning and improve adherence to current clinical guidelines. A double-masked randomised trial was undertaken among fourth-year medical students at Universidad Andres Bello, Chile. Participants were randomised to a clinical virtual simulator (Body Interact®, Body Interact Inc., Austin, TX) or a small-group discussion session on the management of myocardial infarction. Main outcomes included performance in an objective structured clinical examination (OSCE) and adherence to clinical recommendations. Analyses were undertaken under the intention to treat principle by an independent statistician. Fifty students volunteered to participate. Most were female (30 students, 58.8%) and had a mean age of 23.0±2.7 years. Thirty-two participants (62.8%) had used virtual reality platforms before. Students allocated to the simulator showed better OSCE scores (mean difference: 2.8 points; 95% confidence interval (CI): -3.2 to +8.7 points, p=0.14) and were faster to implement diagnostic and therapeutic interventions, but not in a statistically significant way. Academic performance was slightly improved by the use the simulator, although the overall effect was smaller than expected. This study examined the influence of a clinical virtual simulator on the academic performance and guideline adherence of undergraduate medical students, with small group discussions as a point of comparison. The findings revealed that there were no statistically significant distinctions between the two methods, potentially attributed to the selection of the comparator and the relatively brief intervention period.

The Impact of Online vs Blended Clinical Skill Laboratory Learning on Student Academic Performance: A Case Study in Indonesia

ObjectiveOnline and blended learning methods have experienced rapid growth in higher education due to the COVID-19 pandemic. Our study aimed to compare students’ academic performance between online and blended Clinical Skill Laboratories (CSL) learning in undergraduate medical students. MethodsA total of 101 undergraduate medical students at Maulana Malik Ibrahim State Islamic University, Malang, Indonesia, were enrolled (50 students from the academic year 2020 [group 1: online CSL]; 51 students from the academic year 2020 [group 2: blended CSL]). The main outcome was students’ academic performance collected from the Objective Structured Clinical Examination (OSCE) score. Additionally, students also completed an evaluation questionnaire to assess the quality of the learning scheme. ResultsBoth groups agreed that CSL is an important subject and clinical video demonstration is useful for their OSCE preparation. However, students who received online learning felt that online CSL was ineffective and scored lower in the OSCE compared to the blended CSL. Qualitative data also supported these findings. ConclusionBlended learning provides more value than online learning in terms of teaching clinical skills for undergraduate medical students. Additionally, online CSL may not be sufficient for medical students to attain critical skills.

Comparison of pharmacy student, evaluator, and standardised patient assessment of Objective Structured Clinical Examination (OSCE) performance

Objective: The study aimed to (1) determine if standardised patient (SP) assessment of student communication differs from faculty assessment and (2) identify factors that may affect their assessment scoring since differences between evaluator scoring could impact students’ learning and feedback. Methods: Students completed four OSCEs in spring 2022. Communication skills were scored using a global assessment rubric completed by a faculty evaluator, SP, and student. SPs and students rated their confidence in student recommendations on a scale of 1-5 (1=lowest; 5=highest). Spearman correlation and Wilcoxon matched-pairs signed rank tests were used for analysis. Results: SP global assessment scores were statistically significantly higher than faculty scores. SP global assessment and confidence scores were strongly correlated. Conclusion: Differences in OSCE scoring among evaluator types and factors that may impact scoring are important to explore. SP scores were consistently higher than faculty scores, which should be considered when using OSCEs as assessments.

Examination Scores but not Clinical Performance Correlate With Duration of Preclinical Didactic Time: A Synchronous Comparison of Second- Versus Third-Year Medical Students on the Surgery Clerkship

Numerous institutions have reduced preclinical didactic time to facilitate earlier clinical exposure during the second year of medical education. However, the effects that shortened preclinical education may have on performance in the surgery clerkship are unclear. This study aims to compare the clinical and examination performance of second- (MS2) and third-year (MS3) students synchronously completing an identical surgery clerkship. All students completing the surgery clerkship (identical didactics, examinations, clinical rotations, etc.) were included. MS3s received 24 months of preclinical education, whereas MS2s received 14 months. Performance outcomes included weekly quizzes based on lectures, NBME Surgery Shelf Exam, numeric clinical evaluations, objective structured clinical examination (OSCE) scores, and overall clerkship grades. University of Miami Miller School of Medicine. All second- (MS2) and third-year (MS3) medical students completing the Surgery Clerkship over 1 year (n = 395). There were 199 MS3 (50%) and 196 MS2 (50%) students. MS3s demonstrated higher median shelf exams (77% vs 72% MS2s), weekly quiz score averages (87% vs 80% MS2s), clinical evaluations (96% vs 95% MS2s), and overall clerkship grades (89% vs 87% MS2s), all p < 0.020. There was no difference in median OSCE performance (both 92%; p = 0.499). A greater proportion of MS3 students performed in the highest 50% of weekly quiz scores (57% vs 43% MS2), NBME shelf exams (59% vs 39% MS2), and overall clerkship grades (45% vs 37% MS2), all p < 0.010. No significant difference in the proportion of students placing in the top 50% of clinical parameters including the OSCE (48% MS3 vs 46% MS2; p = 0.106) and clinical evaluations (45% MS3 vs 38%; p = 0.185) was observed. Although the duration of preclerkship education may correspond to examination scores, MS2s and MS3s perform similarly on clinical metrics. Future strategies to enhance available preclinical didactic time and preparation for examinations are needed.

Cross-sectional study in Madagascar demonstrates efficacy of virtual mentoring and flipped classroom modifications of neonatal resuscitation programme Helping Babies Breathe.

The Covid-19 pandemic necessitated virtual adaptation of the neonatal resuscitation programme Helping Babies Breathe (HBB). This study assessed one such virtually mentored and flipped classroom modification in Madagascar. A cross-sectional study was performed in September 2021 and May 2022. Healthcare providers were identified by local collaborating organisations. United States-based master trainers collaborated with local trainers on virtually mentored trainings followed by independent trainings. Master trainers were available for consultation via Zoom during the virtual training. A flipped classroom modification and traditional didactic method were compared. Primary outcomes were knowledge and skill acquisition, evaluated by written assessments and objective structured clinical examinations. Overall, 97 providers completed the curriculum. Written assessment scores improved in both training models (traditional-74.8% vs 91.5%, p < 0.001; flipped classroom-89.7% vs 93.6%, p < 0.05). There was no significant difference among written assessment scores (92.8% vs 91.5%, p = 0.62) and significantly higher objective structured clinical examination scores (97.3% vs 89.5%, p < 0.001) for the independent training compared to the virtually mentored training. The virtually mentored HBB training was followed by a successful independent training as measured by participant knowledge and skill acquisition, supporting the efficacy of virtual dissemination.

Student experiences of simulation-based learning and its impact on their performance in Objective Structured Clinical Examination in Pediatrics - A mixed method study.

This study aims to assess the effectiveness of integrating simulation for teaching pediatric clinical examination skills to undergraduate, MBBS Year-IV medical students at The Aga Khan University, Karachi, Pakistan. In this mixed method study, the Objective Structured Clinical Examination (OSCE) scores of the students who were taught using simulation (batch 2017-2018) were compared with the batch of the academic year 2016 -2017 (taught via traditional methods). In order to explore the experiences of the intervention group, a questionnaire with four open-ended questions was administered at the end of the clerkship. Students who were taught by simulation, scored significantly higher on the clinical skills stations in Objective Structured Clinical Examination, than in the pre-intervention group (p-value <0.01). The students quoted safety of the learning environment, opportunities for deliberate practice, debriefing and facilitation skills maximized quoted that their experience of learning through simulation, however, some challenges were identified for future improvement. The result of the study suggested simulation as a useful instructional strategy for teaching examination skills to students in their early years. The student gained confidence through deliberate practice and feedback without compromising patient safety, which translated into improved performance in the high-stakes OSCE examination at the end of the clerkship.

Assessment of Saudi MEDs framework competence in performing clinical and practical skills by final-year medical students

Clinical examinations and practical clinical skills are essential to guide diagnosis and treatment. Competency-based medical education (CBME) is high on today’s medical education agenda, and competence has become the unit of medical education planning in many countries. With the rise of medical education in Saudi Arabia, The Saudi MEDs initiative began as a means of achieving national consensus and developing necessary learning outcomes for medical schools. The aim of this study is to evaluate the final-year medical students’ core clinical competencies and identify the gaps between clinical skills in the Saudi MEDs framework and students’ actual achievement. Online data collection from all fifth-year medical students, to assess their clinical and procedural skills by using Objective Structured Clinical Examination (OSCE) scores and using a self-administered questionnaire that has been developed based on the Saudi MEDs framework. Eight clinical competencies were chosen out of the 17 after consulting the experts in this field. OSCE scores were checked for correlation with their self-assessment scores. The total OSCE scores of 323 students were evaluated which showed 93% of students have passed all eight competencies. Also, 304 students responded to the self-administered questionnaire in the current Saudi MEDs competencies 323 (response rate=94.11). The students were confident in the majority of the eight clinical competencies of the Saudi MEDs framework. Saudi MEDs framework has ensured that Saudi medical or health care education adapted to changing demands, critical competencies are not overlooked, teaching and learning, and evaluation are appropriate at medical schools by implementing the competency framework.

Comparability of Objective Structured Clinical Examinations (OSCEs) and Written Tests for Assessing Medical School Students' Competencies: A Scoping Review.

Objective Structured Clinical Examinations (OSCEs) and written tests are commonly used to assess health professional students, but it remains unclear whether the additional human resources and expenses required for OSCEs, both in-person and online, are worthwhile for assessing competencies. This scoping review summarized literature identified by searching MEDLINE and EMBASE comparing 1) OSCEs and written tests and 2) in-person and online OSCEs, for assessing health professional trainees' competencies. For Q1, 21 studies satisfied inclusion criteria. The most examined health profession was medical trainees (19, 90.5%), the comparison was most frequently OSCEs versus multiple-choice questions (MCQs) (18, 85.7%), and 18 (87.5%) examined the same competency domain. Most (77.5%) total score correlation coefficients between testing methods were weak (r < 0.40). For Q2, 13 articles were included. In-person and online OSCEs were most used for medical trainees (9, 69.2%), checklists were the most prevalent evaluation scheme (7, 63.6%), and 14/17 overall score comparisons were not statistically significantly different. Generally low correlations exist between MCQ and OSCE scores, providing insufficient evidence as to whether OSCEs provide sufficient value to be worth their additional cost. Online OSCEs may be a viable alternative to in-person OSCEs for certain competencies where technical challenges can be met.

Clinical experience can compensate for inferior academic achievements in an undergraduate objective structured clinical examination

BackgroundPractical and non-cognitive skills are essential to medical professions; yet, success in medical studies is primarily assessed with cognitive criteria. We show that practical exams can benefit students who have only average high school final grades, but working experience in medical professions.MethodsWith a cross-sectional study, we compare the performance of undergraduate medical students with working experience in adjacent health-care professions (and below-average school leaving-grades) with students who entered medical school directly based on their excellent school records in an Objective Structured Clinical Examination (OSCE). For a sample of more than 1,200 students, we use information on OSCE scores in medical and practical skills, doctor-patient communication/interaction, performance in MC-exams, and core sociodemographic variables.ResultsWaiting list students outperformed their classmates in the demonstration of practical skills. Students admitted via their excellent school grades scored best overall. This difference vanishes once we control for school-leaving grade and age, the two main factors separating the analysed groups. Students from the waiting list have a significantly smaller overall chance to reach excellent grades in the first two years of study.ConclusionsStudents who gathered experiences in health-care professions before enrolling at medical school can benefit from an expanded role of practical elements in medical studies. Student selection instruments should take these different starting positions and qualities of applicants into account, for example with a quota for the professionally experienced.

Using tele-ultrasound to teach medical students: A randomised control equivalence study.

Undergraduate ultrasound education is becoming increasingly important, but its expansion is limited by time, space and the availability of trained faculty. In order to validate an alternative and more accessible teaching model, our aim was to assess whether combining teleguidance and peer-assisted learning to teach ultrasound is as effective as traditional in-person methods. Peer instructors taught 47 second-year medical students ocular ultrasound via either teleguidance or traditional in-person methods. Proficiency was assessed using a multiple-choice knowledge test and objective structured clinical examination (OSCE). Confidence, overall experience, and experience with a peer instructor were measured using a 5-point Likert scale. Two one-sided t-tests were used to measure equivalency between the two groups. The null hypothesis that the two groups were not different was rejected when P < 0.05. The teleguidance group performed as well as the traditional in-person group in terms of knowledge change, confidence change, OSCE time and OSCE score (p=0.011, p=0.006, p=0.005 and =0.004, respectively, indicating the two groups are statistically equivalent). The teleguidance group rated the experience highly overall (4.06/5), but less than the traditional group (4.47/5; P=0.448, indicating statistical difference). Peer instruction was rated 4.35/5 overall. Peer-instructed teleguidance was equivalent to in-person instruction with respect to knowledge change, confidence gain and OSCE performance in basic ocular ultrasound.

Objective Structured Clinical Examination as A Reliable tool in the Summative Evaluation of Final Year Medical Students at Enugu State University College of Medicine

Objective structured clinical examination (OSCE) is a reliable, objective and reproducible method of summative assessment of clinical competence. The aim of this study is to evaluate the reliability of OSCE for summative evaluation of final year medical students in both Internal Medicine and Surgery. This was a retrospective cross-sectional study of summative assessment of final-year medical students in Internal Medicine and Surgery at College of Medicine, Enugu State University of Science and Technology. The students’ clinical competence was tested by OSCE. The OSCE consisted of two parts. The A part (picture OSCE, replacing traditional short cases) in which questions were given to students from slide shows. The B part (clinical OSCE, replacing traditional long case) consisted of clinical OSCE stations to test students’ ability and skills in history taking, physical examination, counselling/communication skills, ability to make diagnosis, interpretation of laboratory/radiological results and ability to manage common medical emergencies and conditions. The students' scores in the picture OSCE, clinical OSCE, and final total clinical score scores in both Internal Medicine and Surgery were collated and subjected to analysis with SPSS version 25 (IBM; SPSS, Chicago, IL, USA). Correlation was assessed by Pearson correlation, mean scores compared with paired t-test, reliability assessed by calculating Cronbach's alpha. Statistical significance was considered as p &lt;0.05. A total of 120 students sat for the examinations. There were significant positive correlations between students’ score in Surgery clinical OSCE and Internal Medicine clinical OSCE, r =0.617 (p=0.000); students’ scores in Surgery picture OSCE and Internal Medicine Picture OSCE, r=0.647 (p=0.000); and students’ scores in Surgery clinical examinations and Internal Medicine clinical examinations, r= 0.750 (p=0.000). The reliability of Surgery clinical examinations was 0.851 while the reliability of Internal Medicine clinical examinations was 0.816. OSCE is a more reliable tool than traditional method for the summative assessment of final year medical students. OSCE gives a higher correlation coefficient and Cronbach alpha than the traditional method of assessment.

Effectiveness of Near-Peer Versus Faculty Point-of-Care Ultrasound Instruction to Third-Year Medical Students.

Background: Incorporation of point-of-care ultrasound (POCUS) in undergraduate medical education (UME) is expanding; however, its effective implementation is impeded by a lack of trained faculty. Recruitment of near-peer (NP) instructors is a potential solution, but there are concerns surrounding NP teaching effectiveness compared to faculty instruction. While some institutions have assessed supplemental NP instruction, or NP-taught sessions with strict faculty supervision, few if any have compared effectiveness of NP POCUS instruction alone to faculty instruction through a multi-dimensional assessment. The aim of this study was to compare the effectiveness of near-peer (NP) instruction to faculty instruction at an undergraduate medical education clinical POCUS session for third-year medical students. Methods: This was a randomized controlled trial where third-year medical students were assigned to one of two groups for a 90-minute POCUS session: NP instruction or faculty instruction. A pre- and post-session multiple-choice test and a post-session objective structured clinical examination (OSCE) were administered to assess conceptual and hands-on clinical POCUS knowledge gained. Students' perceptions of the instructors and session were evaluated using a Likert scale. Results: Seventy-three students (66% of the class) participated; 36 taught by faculty and 37 by NP instructors. Both groups showed a significant score increase from pre-test to post-test (p =0.002); however, there was no significant difference between groups in post-test (p=0.27) nor OSCE scores (p=0.20). Student perceptions of instructor competency were not statistically significant. Conclusions: NP instructors were as effective at teaching clinical POCUS to third-year medical students as faculty instructors at our institution.

Evaluation of a Novel Point-of-Care Ultrasound Curriculum for First-Year Pediatric Residents.

The aim of the study is to evaluate a novel point-of-care ultrasound (POCUS) educational curriculum for pediatric residents. The cohort study in graduate medical education was completed from January 2017 to March 2019. Postgraduate year 1 (PGY1) pediatric residents attended the educational curriculum that consisted of 3 half-day sessions over a 3-month period. Each session consisted of a lecture (introduction, extended focused assessment with sonography for trauma, soft tissue/musculoskeletal, cardiac, and resuscitative applications) followed by supervised hands-on scanning sessions. Group ratio was 3 learners to 1 machine/expert instructor. Main outcome measures included pre- and post-written test scores, as well as objective structured clinical examination (OSCE) scores. Forty-nine PGY1 residents (78% women) completed the curriculum. The mean (SD) pretest score was 68% (8.5), and the mean posttest score was 83% (8.3) with a difference of 15 (95% confidence interval, 12.5-17.6; P < 0.001). Mean (SD) focused assessment with sonography for trauma OSCE score after the curriculum was 88.7% (11.9). The number of PGY1 pediatric residents that were comfortable performing POCUS examinations increased from pretraining to posttraining for soft tissue/musculoskeletal (14%-61%, P < 0.001), extended focused assessment with sonography for trauma (24%-90%, P < 0.001), and cardiac (18%-86%, P < 0.001). All participants found the curriculum useful, and 42 of 49 (86%) stated the curriculum increased their ability to acquire and interpret images. Postgraduate year 1 pediatric residents learned the basics of POCUS through 3 brief educational sessions. The increase in posttest scores demonstrated improved POCUS knowledge, and the high OSCE score demonstrated their ability to acquire ultrasound images. Point-of-care ultrasound guidelines are needed for pediatric residency programs.

The use of peer role-play in doctor-patient communication skills training for medical students: A systematic review

The quality of communication is directly related to patient satisfaction and can influence health outcomes. However, most doctors still have poor communication skills. A systematic literature search in PubMed, Cochrane, and Science Direct was conducted to retrieve studies reporting the use of peer role-play (PRP) for doctor-patient communication skills training in medical students. The quality of each study was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. A total of 1,620 studies were obtained from electronic database search and screening of reference lists. After removing irrelevant studies and duplicates, one randomized control trial (RCT) and eight quasi-experimental studies were included in this systematic review. Peer role-play was perceived to be as useful as simulated patients (SP) training methods with comparable post-intervention objective structured clinical examination (OSCE) scores. Majority of students preferred PRP for learning communication skills over didactic lectures. The limitation of this review is the scarcity of eligible studies, high variability in the PRP programs across studies, and the lack of grey literature included. Peer role-play might be a cost-effective method to improve doctor-patient communication skills with comparable results (student’s perception and OSCE scores) with the expensive use of simulated patients. However, further study is needed to support this statement.

A structured multimodal teaching approach enhancing musculoskeletal physical examination skills among undergraduate medical students

ABSTRACT Current evidence indicates that undergraduate medical students display deficits in musculoskeletal physical examination skills (MPES). While various instructional methods are recommended for teaching clinical skills, effective methods for teaching MPES have not been established. This study compared the effectiveness of a multimodal teaching approach incorporating video-based learning, interactive small-group teaching, hands-on practicing, peer-assisted learning, formative assessment, and constructive feedback with traditional bedside teaching in developing undergraduate orthopedic MPES. Participants were 151 fifth-year medical students divided into two groups. One group received multimodal teaching, and the other received traditional bedside teaching. In both groups, the participants learned how to physically examine the knee and shoulder. The primary outcome was objective structured clinical examination (OSCE) scores, while the secondary outcomes included teaching sessions’ total durations, facilitator’s demonstration time, participants’ practice time, and proportion of students with passing checklist scores and global ratings-based assessments for the two teaching approaches. The multimodal teaching group had significantly higher OSCE scores (checklist scores, global ratings, and passing rates; p = 0.02, 0.02, 0.01, respectively) than the comparison group. Individual OSCE component assessments showed significant improvements in the special musculoskeletal physical examination test. The overall duration and amount of participants’ hands-on time were significantly longer for the multimodal than for the traditional bedside teaching group (p = 0.01 and 0.01, respectively), and the facilitator’s demonstration time was significantly shorter (p = 0.01). The multimodal learner-centered teaching approach evaluated in this study was effective for teaching MPES. It appeared to maximize learner engagement through enhancing interactions and providing increased time to engage in hands-on practice. This teaching approach improved MPES levels, maximized teaching efficiency for scenarios with limited instruction time and resources, and enhanced competency of undergraduate medical students in performing special musculoskeletal physical examinations compared to traditional bedside teaching.

Antibiotic prescription errors: the relationship with clinical competence in junior medical residents

BackgroundA large portion of prescribing errors can be attributed to deficiencies in medication knowledge. These errors are preventable and most often occur at the time of prescription. Antimicrobials are the drug class most common incorrectly prescribed.ObjectiveTo characterize the relationship between clinical competence and antibiotic prescription errors. We also investigated the frequency and severity of antibiotic prescription errors to identify items and attributes of clinical competence which are correlated with the antibiotic prescription error ratio.MethodA cross-sectional study was applied to assess clinical competence of junior medical residents in two reference academic hospitals and a regional hospital in Mexico City. It was conducted during February 2019. We used an infectious disease Objective Structured Clinical Examination (OSCE) to assess clinical competence and a measure of frequency, and severity of antibiotic prescription errors.ResultsThe number of eligible participants was ~ 255 (hospital meeting attendance), and the number of residents in this study were 51 (~ 20%), 31 were female (60.8%). The mean OSCE score was 0.692 ± 0.073. The inter-item (Cronbach’s alpha = 0.927) and inter-station internal consistency was adequate (Cronbach’s alpha = 0.774). The G coefficient in generalizability theory analysis was 0.84. The antibiotic prescription error ratio was 45.1% ± 7%. The most frequent category of severity of antibiotic prescription errors was category E (errors that may contribute to or result in temporary harm to the patient and require intervention), 235 (65.2%). We observed a negative and significant correlation between clinical competence and antibiotic prescription errors (r = -0.33, p < 0.05, CI95% -0.57 to -0.07), which remained significant after controlling for the effect of gender and time since graduation from medical school (r = -0.39, p < 0.01, CI95% -0.625 to -0.118). Using exploratory factor analysis we identified two factors, which explained 69% of the variance in clinical competence, factor 1 evaluated socio-clinical skills and factor 2 evaluated diagnostic-therapeutic skills. Factor 2 was correlated with antibiotic prescription error ratio (r = -0.536, p < 0.001).ConclusionsWe observed a negative correlation between clinical competence and antibiotic prescription error ratio in graduated physicians who have been accepted in a medical specialty. The therapeutic plan, which is a component of the clinical competence score, and the prescription skills had a negative correlation with antibiotic prescription errors. The most frequent errors in antibiotic prescriptions would require a second intervention.

Exploring the situational motivation of medical students through clinical medicine level test: a cross-sectional study

China's Clinical Medicine Level Test (CMLT) was designed to evaluate the key factors that affect the learning outcome of medical students prior to entering clinical practice. In this study, we systemically analyzed the performance of a cohort of medical students at Jinan University School of Medicine participating in the recent CMLT. The analytical results of the medical students' written and objective structured clinical examination (OSCE) scores showed that their academic performance was predominantly associated with students' internship allocations, although other demographic characteristics such as sex, age, geographical origin of students, and grade point average (GPA) might be sporadically related to the students' OSCE performance at different OSCE stations. To explore the inherent reasons behind this, a survey was implemented among the medical students who participated in the examination to further interpret the factors influencing the students' learning outcome. The findings of this questionnaire manifested that intrinsic motivation and identified regulation acted as the major motivational profiles for the medical students from three different internship sites, whereas external regulation emerged as the crucial factor to make the students perform well academically in the CMLT. The result of this study suggested that strengthening the quality control of the clinical learning environment and improving medical administration may still be the most effective approaches to ensure the quality of clinical medical education.