Subsequent Clinical Performance Research Articles

Role of social comparison in preparedness for practice as a junior doctor in Singapore: a longitudinal qualitative study

ObjectivesTo date, most research on medical graduates’ preparedness for practice has conceptualised preparedness as something possessed by the individual. However, new doctors work within social settings with other people and,...

11 Understanding the Clinical Performance of Ceramic Coated Femoral Components in Knee Arthroplasty Surgery

Abstract Aim In vitro knee simulation has demonstrated favourable wear properties and decreased metal ion release of ceramic coated metal femoral components in total knee arthroplasty surgery. Femoral implants coated with ceramic have been used in patients, however the subsequent clinical performance and time-to-revision of these implants is largely unknown. The scope of this study was to review the current available clinical literature, focusing on retrieval studies of Ceramic-Coated TKAs. Method Literature review of PubMed and MEDLINE. All studies included demonstrated clinical evaluation of implant performance, either in vivo or at revision. Results 9 studies were identified and included for analysis in this study. Retrieval analysis has illustrated microscopic defects in coatings of revised implants, with associated abrasion and 3rd body wear of the polyethylene component. Evidence suggests that coating femoral components with ceramic can prevent effective cement bonding, leading to aseptic loosening and thus earlier implant failure. Despite these problems, high volume centres have been able to demonstrate comparable results when compared with traditional bearing surface combinations. The mechanism behind metal ion hypersensitivity is currently poorly understood; however, the use of ceramic coated knee replacements is demonstrating a reduction in metal ion release. Conclusions Whilst conferring favourable clinical properties in certain instances, the lack of surgical, implant and patient data surrounding the use of this coated implants remains concerning. The literature base remains limited, and meaningful clinical conclusions cannot be drawn. Recommendations include performing robust clinical trials in order to delineate the clinical efficacy of ceramic coatings in knee arthroplasty.

The Effectiveness of Students' Performance in Preclinical Fixed Prosthodontics Course in Predicting Subsequent Clinical Performance.

To evaluate the correlation between students' achieved grades in a preclinical fixed prosthodontics course and their performance in the same discipline's clinical courses. This study was conducted in 2019 on 76 students who passed all preclinical and clinical fixed prosthodontics courses. Their final examination grades in preclinical and clinical prosthodontics courses were compiled and made anonymous. The Statistical Package for the Social Sciences (SPSS Version 23) was used to analyze the data. Descriptive statistics and correlation coefficient were used to assess the relation between preclinical and clinical grades. A statistically significant positive correlation existed between the students' preclinical and combined clinical final examination grades (r = 0.45, p < 0.001). In relation to sex, females showed a significantly higher correlation (r = 0.56, p = 0.001) compared to males (r = 0.25, p = 0.1). In addition, students' clinical grade prediction from their preclinical performance was 20.5%. These findings emphasize the importance of preclinical courses and suggest that maximizing preclinical years' efforts can reflect positively on students' competence in their future clinical practice.

Predicting Quality of Clinical Performance From Cardiology Fellowship Applications.

Variables in cardiology fellowship applications have not been objectively analyzed against applicants' subsequent clinical performance. We investigated possible correlations in a retrospective cohort study of 65 cardiology fellows at the Mayo Clinic (Rochester, Minn) who began 2 years of clinical training from July 2007 through July 2013. Application variables included the strength of comparative statements in recommendation letters and the authors' academic ranks, membership status in the Alpha Omega Alpha Honor Medical Society, awards earned, volunteer activities, United States Medical Licensing Examination (USMLE) scores, advanced degrees, publications, and completion of a residency program ranked in the top 6 in the United States. The outcome was clinical performance as measured by a mean of faculty evaluation scores during clinical training. The overall mean evaluation score was 4.07 ± 0.18 (scale, 1-5). After multivariable analysis, evaluation scores were associated with Alpha Omega Alpha designation (β=0.13; 95% CI, 0.01-0.25; P=0.03), residency program reputation (β=0.13; 95% CI, 0.05-0.21; P=0.004), and strength of comparative statements in recommendation letters (β=0.08; 95% CI, 0.01-0.15; P=0.02), particularly in letters from residency program directors (β=0.05; 95% CI, 0.01-0.08; P=0.009). Objective factors to consider in the cardiology fellowship application include Alpha Omega Alpha membership, residency program reputation, and comparative statements from residency program directors.

Performance in Simulation Is Associated With Clinical Practice Performance in Physical Therapist Students

Introduction. Simulation-based clinical education is often adopted before clinical practice to provide health professional students with practice in a safe environment. The simulated environment is often presumed to replicate clinical practice, but performance in these settings is likely to be different. Simulation may be able to determine student clinical competency before clinical practice. However, there is little research comparing health professional student performance in simulation followed by clinical practice. The aim of the study was to determine whether there was an association between the performance of physical therapist students in simulation and clinical practice and whether aspects of simulation performance could predict subsequent clinical performance. Methods. We measured clinical performance of 148 graduate entry-level master physical therapist students using the Assessment of Physiotherapy Practice (APP) tool (n = 296) at the end of 2 weeks of simulation and subsequent 3 weeks of clinical practice. Assessments were conducted by clinical educators. Data were analyzed using Pearson correlation and multiple regression with backward elimination for exploring predictors of clinical performance. Results. A significant association was found between student performance in simulation and clinical practice (r = .40, P &lt; .001). Two domains of practice of the APP in simulation assessments, “analysis and planning” and “risk assessment,” were found to be predictive of student performance in subsequent clinical practice. Discussion and Conclusion. The association between physical therapist student performance in simulation and clinical practice adds support for simulation assessments being used to determine subsequent clinical practice performance. Educators may consider focusing on learner development in the domains of practice of “analysis and planning” and “risk assessment” in simulation as a way of assisting physical therapist student preparation for clinical practice and facilitating more effective implementation of simulation-based education practices.

Panel interview for internal medicine residency selection: pros and cons.

Selection of residents is an extremely important process for a residency program as it determines the quality of patient care as well as the academic and research progress of the program. Most studies have focused on the relationship between the national board exam scores, such as the United States Medical Licensing Examination (USMLE) and the subsequent clinical performance of the selected residents. However, a low to moderate correlation has been found between board scores and residency performance.1 Additionally other studies have assessed the residency program directors’ opinions about the relative importance of various selection strategies. They found the top three common selection elements were clerkship grades, reference letters, and the USMLE Step 1 scores.2 There is no consensus as to which selection strategy is the most useful in choosing the candidates. Thus, the existing selection process is not ideal and has many shortcomings. For instance, it may not give an accurate representation of the interviewee as a medical resident.3 Likewise, there may be a major reliance on one parameter, such as the USMLE scores. This may come at the expense of other parameters, such as the candidate’s communication skills, character, and professionalism.4 Also, there is inter- and intra-observer variability in rating the residency candidates. These shortcomings make the selection process subjective and unreliable, which should be avoided when making assessments.5 Adopting a new interview style During the 2015-2016 interview season, the University of Toledo Internal Medicine Residency Program introduced a panel-style interview. Previously, the residency program relied on one-on-one interviews with various faculty members to evaluate candidates. Changing the interview style allowed an opportunity for multiple interviewers (the panel) to evaluate a residency candidate. Our panel members consisted of the program director/associate program director, a faculty member, and the chief resident. Also, under the one-on-one interview format, it allowed the interviewer greater access to beforehand knowledge of the candidate, which was changed under the panel interview style. Instead, the interviewers were blinded to the objective criteria, such as USMLE scores. After completion of the interview, the panel members individually scored the residency candidate using various subjective elements, such as communication skills, teaching potential, and professionalism. Subsequently, these scores were used by the residency program to calculate the final rankings of all the candidates during the interview season.

Predictors of medical school clerkship performance: a multispecialty longitudinal analysis of standardized examination scores and clinical assessments.

BackgroundEvidence suggests that poor performance on standardized tests before and early in medical school is associated with poor performance on standardized tests later in medical school and beyond. This study aimed to explore relationships between standardized examination scores (before and during medical school) with test and clinical performance across all core clinical clerkships.MethodsWe evaluated characteristics of 435 students at Mayo Medical School (MMS) who matriculated 2000–2009 and for whom undergraduate grade point average, medical college aptitude test (MCAT), medical school standardized tests (United States Medical Licensing Examination [USMLE] 1 and 2; National Board of Medical Examiners [NBME] subject examination), and faculty assessments were available. We assessed the correlation between scores and assessments and determined USMLE 1 cutoffs predictive of poor performance (≤10th percentile) on the NBME examinations. We also compared the mean faculty assessment scores of MMS students vs visiting students, and for the NBME, we determined the percentage of MMS students who scored at or below the tenth percentile of first-time national examinees.ResultsMCAT scores correlated robustly with USMLE 1 and 2, and USMLE 1 and 2 independently predicted NBME scores in all clerkships. USMLE 1 cutoffs corresponding to poor NBME performance ranged from 220 to 223. USMLE 1 scores were similar among MMS and visiting students. For most academic years and clerkships, NBME scores were similar for MMS students vs all first-time examinees.ConclusionsMCAT, USMLE 1 and 2, and subsequent clinical performance parameters were correlated with NBME scores across all core clerkships. Even more interestingly, faculty assessments correlated with NBME scores, affirming patient care as examination preparation. USMLE 1 scores identified students at risk of poor performance on NBME subject examinations, facilitating and supporting implementation of remediation before the clinical years. MMS students were representative of medical students across the nation.

Sustained effect of simulation-based ultrasound training on clinical performance: a randomized trial.

ObjectiveTo study the effect of initial simulation-based transvaginal sonography (TVS) training compared with clinical training only, on the clinical performance of residents in obstetrics and gynecology (Ob-Gyn), assessed 2 months into their residency.MethodsIn a randomized study, new Ob-Gyn residents (n = 33) with no prior ultrasound experience were recruited from three teaching hospitals. Participants were allocated to either simulation-based training followed by clinical training (intervention group; n = 18) or clinical training only (control group; n = 15). The simulation-based training was performed using a virtual-reality TVS simulator until an expert performance level was attained, and was followed by training on a pelvic mannequin. After 2 months of clinical training, one TVS examination was recorded for assessment of each resident's clinical performance (n = 26). Two ultrasound experts blinded to group allocation rated the scans using the Objective Structured Assessment of Ultrasound Skills (OSAUS) scale.ResultsDuring the 2 months of clinical training, participants in the intervention and control groups completed an average ± SD of 58 ± 41 and 63 ± 47 scans, respectively (P = 0.67). In the subsequent clinical performance test, the intervention group achieved higher OSAUS scores than did the control group (mean score, 59.1% vs 37.6%, respectively; P < 0.001). A greater proportion of the intervention group passed a pre-established pass/fail level than did controls (85.7% vs 8.3%, respectively; P < 0.001).ConclusionSimulation-based ultrasound training leads to substantial improvement in clinical performance that is sustained after 2 months of clinical training. © 2015 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

Performance of speech-language pathology students in problem-based learning tutorials and in clinical practice

The purpose of the study was to identify if performance of speech-language pathology students in problem-based learning (PBL) tutorials could predict subsequent clinical performance evaluated through (a) a non-standardized, custom clinical evaluation form (HKU form) and (b) a standardized competency assessment for speech pathology developed in Australia (COMPASS®). Students’ scores from PBL tutorial performance were correlated with scores in clinical placement on both the HKU form and the COMPASS. Significant correlations were found between students’ PBL tutorial performance (reflective journals and participation in the tutorial process) and their clinical performance (treatment and interpersonal skills) on the HKU clinical evaluation form. Significant correlations were also found between (a) PBL tutorial performance (participation in the tutorial process) and their clinical performance (all generic and occupational competencies, and the overall score) on the COMPASS, (b) PBL tutorial performance (reading forms) and two occupational competencies on the COMPASS, (c) PBL tutorial performance (reflective journals) and four occupational competencies and the overall score on the COMPASS. The results highlighted the need for validating the assessment for the learning process in PBL tutorials with empirical evidence and the advantage of assessing clinical performance through COMPASS in Hong Kong. Tutors, clinical supervisors and students should be given clear behavioral descriptors for expected performance in PBL tutorials and clinical practice at different year levels.

The Sämisch Case and the Müllers of Wiesbaden

There are significant inconsistencies in accounts in textbooks of the fitting in 1887 of a device resembling a scleral contact lens. The aim of this study was to establish the facts of this case and to provide an overview of the subsequent clinical performance of blown scleral shells and lenses. A literature search was conducted that included the original report published in 1910 of the fitting of the patient. The dimensions and back vertex power of a blown scleral shell were measured. In 1887, the right eye of a patient with lagophthalmic keratitis as a sequel to cancerous destruction of the lower eyelid was fitted with a protective blown scleral shell. His left eye was effectively blind. The referring ophthalmologist was Professor Theodor Sämisch of Bonn and the fitting was undertaken by the firm of F Ad Müller & Söhne of Wiesbaden, Germany. With periodical replacement, a shell was worn for at least 21 years. Müller scleral shells were principally fitted in keratoconus providing markedly improved visual acuities and wearing times of up to 14 h a day. There were instances of continuous wear. Failure to consult original sources is responsible for errors in descriptions of the Sämisch case that is of historical importance because it represents both the first use of a therapeutic contact shell and the first instance of continuous wear. Blown scleral shells and lenses played an important part in the optical correction of keratoconus and the management of other ocular conditions during the first quarter of the 20th century.

Approaches to medical student remediation after a comprehensive clinical skills examination

Most US medical schools conduct comprehensive clinical skills assessments during Years 3 and 4. This study explores strategies used to identify and remediate students who perform poorly on these assessments. In the academic year 2005-06, we conducted 33 semi-structured interviews with individuals responsible for standard setting in and remediation after their schools' comprehensive clinical skills assessments. We coded interviews to identify major themes. Prior to remediation, some schools employed a 'verification' step to ensure the accuracy of the failing score or need for remediation. Participants described a remediation process that included some or all of 3 steps. Firstly, students' specific learning deficits were diagnosed. Next, students participated in remedial activities such as performance review sessions or practice with standardised or actual patients. Lastly, students were re-tested, usually with a shorter, more formative examination. All participants reported using a diagnostic step, most offered or required remedial activities and many re-tested, although schools varied in the emphasis placed on each step. Many participants cited the individualised attention students received from remediation faculty staff as a strength of their approach, although they raised concerns about the substantial time demands placed on remediation faculty. Most respondents reported some dissatisfaction with their school's remediation process, particularly uncertainty about efficacy or rigour. Schools vary in the intensity and scope of remediation offered to students who perform poorly on clinical skills assessments. Although many schools invest significant resources in remediation, the effect of these efforts on students' subsequent clinical performance is unknown.

Training with simulation improves residents’ endovascular procedure skills

Endovascular procedure simulators are now commercially available and in use for physician training. The purpose of this study was to evaluate the role of simulation-based training in vascular surgery residencies. Residents from vascular surgery programs in a five-state area were invited to participate in a series of 2-day endovascular training programs that used a high-fidelity endovascular procedure simulator (SimSuite; Medical Simulation Corporation, Denver, Colo), didactic instruction, computer-based training, and tabletop procedure demonstrations. The curriculum covered arteriography and intervention for treatment of aortoiliac, renal, and carotid artery disease. Nine residents participated, with one to three per training session. Each completed an average of 9.5 simulated endovascular cases. Performance on a standardized TransAtlantic Inter-Society Consensus B iliac angioplasty/stenting case was used to assess endovascular skills and knowledge at the beginning of the training program, and this was repeated at the completion of the training. Performance metrics were measured by the simulator, faculty observed trainees' performance of simulated cases, and trainees provided their evaluations of the usefulness of the simulation experiences. Endovascular procedural skills on the standardized iliac intervention case improved after completion of the training program. Compared with performance early on day 1, performance improved (P < or = .05; paired t test): total procedure time decreased 54%, volume of contrast decreased 44%, and fluoroscopy time decreased 48% (mean change from baseline). Selection of angioplasty balloon catheters and stents was improved, and the average number of catheters used and stents deployed decreased, although this did not reach statistical significance. Faculty observation allowed identification of shortcomings of knowledge and skills, including common problems with selection of catheter, balloon, and stent sizes; correct positioning of the sheath; and intraprocedural monitoring. Postcourse evaluations indicated support for the use of simulation in vascular surgery residents' endovascular training. Training with a simulator, incorporated into an individual or small group learning session, offers a means to learn and realistically practice endovascular procedures without direct risk to patients, with measurable improvements in key performance metrics. How simulation training affects subsequent clinical performance has yet to be established.

Differences Between Students in Problem-Based and Lecture-Based Curricula Measured by Clerkship Performance Ratings at the Beginning of the Third Year

Background: Problem-based learning (PBL) is being incorporated into more medical curricula, but its influence on subsequent clinical performance remains unclear. Purpose: To determine if PBL leads to better scores for fund of knowledge or clinical problem-solving skills in required clerkships taken early in the 3rd year at Penn State College of Medicine. Methods: Data were collected from 6 class years, for clinical clerkship subscores completed during the first 4 months of the 3rd year, of students completing 1 or 2 years in a PBL or traditional track. Clerkship scores were analyzed as individual clerkships and as the average across clerkships for each student. Statistical analysis included a comparison of clerkship scores between the 2 tracks, using a 2-sample t test, and calculation of effect sizes. A multiple regression model was also employed to adjust for age, gender, race, preadmission grade point average, and Medical College Admission Test (MCAT). Results: Mean scores of individual clerkships taken by problem-based or lecture-based students differed significantly in some clerkships, but the effect size was small. The effect sizes for fund of knowledge for the 6 clerkships ranged from 0.20 to 0.41; for clinical problem-solving skills, they ranged from 0.26 to 0.39. These differences between the problem-based and lecture-based students were of the same magnitude as the difference at the start of medical school on the MCAT, namely d = 0.31. There was a trend toward higher effect sizes in students having 2 rather than 1 year of PBL, and in later iterations of the track. Conclusion: PBL effect size on students' scores for fund of knowledge and clinical problem-solving skills was small to moderate in various years.

Information Collected during the Residency Match Process Does Not Predict Subsequent Clinical Performance of Pediatric Residents

Information Collected during the Residency Match Process Does Not Predict Subsequent Clinical Performance of Pediatric Residents

The Empirical Validation of Clinical Teaching Strategies

The precepts for teaching recommended to clinical teachers tend to be based on common sense, practical wisdom, and expert opinion rather than on empirical validation against appropriate outcome measures of learning. This article describes an initial attempt to validate empirically the effectiveness of certain clinical teaching strategies in an Introduction to Clinical Medicine (ICM) course. Students' assessments of their first-year ICM tutors' teaching skills were correlated with those same students' clinicalperformances, as assessed by the students' second-year clinical tutors. There were statistical significant positive correlations between students' ratings of some ICM tutor teaching skills and some aspects of student performance, as evaluated by the second-year clinical tutors. The results suggest that clinical teachers who follow what are generally considered to be "good basic educational principles," such as setting clear expectations, providing adequate supervision, providing feedback, and showing concern for students' progress, have a positive impact on the subsequent clinical performance of their students. Implications for faculty development and further research are discussed.

TECHNIQUES FOR EVALUATING THE EFFECTIVENESS OF PSYCHIATRIC TEACHING

1. Studies in progress for the past two years suggest that we can devise short-answer, multiple-choice tests applicable for examination of large classes which correlate well with subsequent clinical performance. 2. It is suggested that giving separate examinations in clinical description, clinical evaluation, psychotherapeutic techniques and factual knowledge will provide a profile of competency for each student which will highlight his strengths and weaknesses. This should provide a guide for instructors involved in the small-group, tutorial educational system in the clinical years. 3. Such tests even expose psychopathology and defense mechanisms. If the student s markedly deviant from his peers, one should be alerted to the possibility of severe psychopathology. 4. Utilizing available movies and rating scales already standardized on trained personnel seems to be an equitable way to measure the student's capabilities. It also offers an opportunity for interschool comparison of students. 5. It is hoped that such procedures can be designed so that the practice effect will be minimal and that the same exam can be repeated at least once during the four-year medical school curriculum. In this way these instruments could be utilized to evaluate the effectiveness of psychiatric teaching.