Physical Examination Teaching Research Articles

A Curriculum for Ultrasound-Enhanced Physical Examination Rounds

OPEN ACCESSDecember 2, 2013A Curriculum for Ultrasound-Enhanced Physical Examination Rounds David Frost, MD, FRCP(C), Maral Nadjafi, Rodrigo Cavalcanti David Frost, MD, FRCP(C) University of Toronto Google Scholar More articles by this author , Maral Nadjafi Toronto Western Hospital Google Scholar More articles by this author , Rodrigo Cavalcanti University Health Network Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9625 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail Abstract Introduction: This is a curriculum for teaching evidence-based bedside physical examination rounds augmented by bedside point-of-care ultrasound. This resource includes all of the information necessary to present the curriculum, including relevant evidence for physical maneuvers and detailed instructions on how to demonstrate findings by examination and with ultrasound. Methods: The main resource file is a manual to guide clinician teachers with step-by-step instructions and detailed explanations to allow them to conduct bedside sessions whereby physical examination teaching is combined with ultrasound. We have selected eight clinical scenarios particularly given to this combined approach. Topics covered include splenomegaly, ascites, pleural effusion, mitral regurgitation, tricuspid regurgitation, pulmonary hypertension, left-ventricular systolic dysfunction, volume assessment, and examination of the neck vessels. Results: We have evaluated trainee perception of this curriculum's usefulness after a year of implementation. Residents felt that it enhanced physical examination teaching, made them more comfortable with bedside ultrasound, and made them more comfortable performing bedside procedures. We are in the process of objectively assessing competence in performing point of care ultrasound in our trainees. Discussion: This resource represents, to our knowledge, the first comprehensive curriculum that combines evidence-based physical diagnosis teaching with point-of-care ultrasound. We have specifically chosen clinical scenarios that are well suited to this hybrid methodology. Educational Objectives To perform a focused, evidence-based physical examination directed at a specific clinical question.To introduce basic uses of ultrasound technology at the bedside.To incorporate ultrasound teaching into bedside physical examination teaching to support and confirm the physical findings.To stimulate interest in bedside physical examination teaching by incorporating technology. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Instructor Guide.pdf Ultrasound Curriculum.pdf To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. CitationFrost D, Nadjafi M, Cavalcanti R. A Curriculum for Ultrasound-Enhanced Physical Examination Rounds. MedEdPORTAL. 2013;9:9625. https://doi.org/10.15766/mep_2374-8265.9625 Copyright & Permissions© 2013 Frost et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-No Derivatives license.KeywordsClinical CompetencePhysical ExaminationUltrasoundBedside TeachingPoint of CareClinical SkillsHybrid InstructionUltrasonography Disclosures None to report. Funding/Support None to report. Prior Presentations Nadjafi M, Cavalcanti RB, Frost DW. Gel Rounds: Incorporation of bedside ultrasound into clinical teaching rounds. Presented at: International Conference on Residency Education; October 2012; Ottawa, Canada. Nadjafi M, Cavalcanti RB, Frost DW. Incorporating Ultrasound Use for Teaching Physical Examination Skills. Presented at: Association for Medical Education in Europe Conference; August 2012; Lyon, France. Loading ...

Physical Examination Education in Graduate Medical Education—A Systematic Review of the Literature

There is widespread recognition that physical examination (PE) should be taught in Graduate Medical Education (GME), but little is known regarding how to best teach PE to residents. Deliberate practice fosters expertise in other fields, but its utility in teaching PE is unknown. We systematically reviewed the literature to determine the effectiveness of methods to teach PE in GME, with attention to usage of deliberate practice. We searched PubMed, ERIC, and EMBASE for English language studies regarding PE education in GME published between January 1951 and December 2012. Seven eligibility criteria were applied to studies of PE education: (1) English language; (2) subjects in GME; (3) description of study population; (4) description of intervention; (5) assessment of efficacy; (6) inclusion of control group; and (7) report of data analysis. We extracted data regarding study quality, type of PE, study population, curricular features, use of deliberate practice, outcomes and assessment methods. Tabulated summaries of studies were reviewed for narrative synthesis. Fourteen studies met inclusion criteria. The mean Medical Education Research Study Quality Instrument (MERSQI) score was 9.0 out of 18. Most studies (n = 8) included internal medicine residents. Half of the studies used resident interaction with a human examinee as the primary means of teaching PE. Three studies "definitely" and four studies "possibly" used deliberate practice; all but one of these studies demonstrated improved educational outcomes. We used a non-validated deliberate practice assessment. Given the heterogeneity of assessment modalities, we did not perform a meta-analysis. No single strategy for teaching PE in GME is clearly superior to another. Following the principles of deliberate practice and interaction with human examinees may be beneficial in teaching PE; controlled studies including these educational features should be performed to investigate these exploratory findings.

Medical educators' perspectives of teaching physical examinations using ultrasonography at the undergraduate level

Ultrasonography is increasingly used for teaching physical examination in medical schools. This study seeks the opinions of educators as to which physical examinations would be most enhanced by the addition of ultrasonography. We also asked when ultrasound-aided physical examination teaching could have deleterious effects if used outside its intended scope. All of the educators from the University of Calgary Master Teacher Program were invited to complete a 22-item paper-based survey. Survey items were generated independently by two investigators, with input from an expert panel (n = 5). Of the 36 educators, 27 (75%) completed the survey. Examinations identified to be potentially most useful included: measuring the size of the abdominal aorta, identifying the presence/absence of ascites, identifying the presence/absence of pleural effusions, and measuring the size of the bladder. Examinations thought to be potentially most harmful included: identifying the presence/absence of intrauterine pregnancy, measuring the size of the abdominal aorta, and identifying the presence/absence of pericardial effusion. Examinations that are potentially the most useful may also be potentially the most harmful. When initiating an ultrasound curriculum for physical examinations, educators should weigh the risks and benefits of examinations chosen.

Web‐based blog supplement to evidence‐based physical examination teaching

Web‐based blog supplement to evidence‐based physical examination teaching

Effect of Implementing Instructional Videos in a Physical Examination Course

This study examined the effect of implementing instructional video in ophthalmic physical examination teaching on chiropractic students' laboratory physical examination skills and written test results. Instructional video clips of ophthalmic physical examination, consisting of both standard procedures and common mistakes, were created and used for laboratory teaching. The video clips were also available for student review after class. Students' laboratory skills and written test results were analyzed and compared using one-way analysis of variance (ANOVA) and post hoc multiple comparison tests among three study cohorts: the comparison cohort who did not utilize the instructional videos as a tool, the standard video cohort who viewed only the standard procedure of video clips, and the mistake-referenced video cohort who viewed video clips containing both standard procedure and common mistakes. One-way ANOVA suggested a significant difference of lab results among the three cohorts. Post hoc multiple comparisons further revealed that the mean scores of both video cohorts were significantly higher than that of the comparison cohort (p < .001). There was, however, no significant difference of the mean scores between the two video cohorts (p > .05). However, the percentage of students having a perfect score was the highest in the mistake-referenced video cohort. There was no significant difference of written test scores among all three cohorts (p > .05). The instructional video of the standard procedure improves chiropractic students' ophthalmic physical examination skills, which may be further enhanced by implementing a mistake-referenced instructional video.

Assessment of Musculoskeletal Physical Examination Skills and Attitudes of Orthopaedic Residents

Although the musculoskeletal physical examination is an essential part of patient encounters, we believe that it is underemphasized in residency education and that residents' physical examination skills may be lacking. We sought to assess attitudes regarding teaching of the physical examination in orthopaedic residencies, to assess physical examination knowledge and skills among residents, and to develop a method to track the skill level of residents in order to improve our physical examination curriculum. We created a thirty-question multiple-choice musculoskeletal physical examination test and administered it to our residents. We created a five-question survey assessing attitudes toward physical examination teaching in orthopaedic residencies and distributed it to U.S. orthopaedic department chairs We developed an Objective Structured Clinical Examination (OSCE), in which standardized patients enact four clinical scenarios, to observe and assess physical examination skills. The mean score on the multiple-choice physical examination test was 76% despite the fact that our residents consistently scored above 90% on the Orthopaedic In-Training Examination. Department chairs and residents agreed that, although learning to perform the physical examination is important, there is not enough time in the clinical setting to observe and critique a resident's patient examination. The overall score of our residents on the OSCE was 66%. We have exposed a deficiency in the physical examination knowledge and skills of our residents. Although the musculoskeletal physical examination is a vital practice component, our data indicate that it is likely underemphasized in training. Clinic time alone is likely insufficient for the teaching and learning of the musculoskeletal physical examination.

Implementation of an Objective Structured Clinical Exam (OSCE) into Orthopedic Surgery Residency Training

While the musculoskeletal (MSK) physical examination (PE) is an essential part of a patient encounter, we believe it is an underemphasized component of orthopedic residency education and that resident PE skills may be lacking. The purpose of this investigation was to (1) assess the attitudes regarding PE teaching in orthopedic residencies today; (2) develop an MSK objective structured clinical examination (OSCE) to assess the MSK PE knowledge and skills of our orthopedic residents. Prospective, uncontrolled, observational. A major Midwestern tertiary referral center and academic medical center. The orthopedic surgery residents in our program. Twenty-two of 24 completed the OSCE. Surveys showed that residents agreed that although learning the PE is important, there is not enough time in clinic to actually observe and critique a resident examining a patient. For the 22 residents (postgraduate year [PGY] 2-5) who participated in the OSCE, the overall score was 66%. Scores were significantly better for the trauma scenario (78%; p < 0.05) than for the shoulder (67%), spine (64%), and knee (59%) encounters. The overall scores for each component of the OSCE were: (1) history 53%; (2) PE 60%; (3) 5-question posttest 64%; and (4) communication skills 90%. We have exposed a deficiency in the PE knowledge and skills of our residents. Clinic time alone may be insufficient to both teach and learn the MSK PE. The use of a MSK OSCE, while novel in orthopedics, will allow more direct observation of our residents MSK PE skills and also allow us to follow resident skills longitudinally through their training. We hope that our efforts will encourage other programs to assess their PE curriculum and perhaps prompt change.

The impact of trained patient educators on musculoskeletal clinical skills attainment in pre-clerkship medical students

BackgroundDespite the high burden of musculoskeletal (MSK) diseases, few generalists are comfortable teaching MSK physical examination (PE) skills. Patient Partners® in Arthritis (PP®IA) is a standardized patient educator program that could potentially supplement current MSK PE teaching. This study aims to determine if differences exist in MSK PE skills between non-MSK specialist physician and PP®IA taught students.MethodsPre-clerkship medical students attended 2-hour small group MSK PE teaching by either non-MSK specialist physician tutors or by PP®IA. All students underwent an MSK OSCE and completed retrospective pre-post questionnaires regarding comfort with MSK PE and interest in MSK.Results83 students completed the OSCE (42 PP®IA, 41 physician taught) and 82 completed the questionnaire (42 PP®IA, 40 physician taught). There were no significant differences between groups in OSCE scores. For all questionnaire items, post-session ratings were significantly higher than pre-session ratings for both groups. In exploratory analysis PP®IA students showed significantly greater improvement in 12 of 22 questions including three of five patient-centred learning questions.ConclusionsPP®IA MSK PE teaching is as good as non-MSK specialist physician tutor teaching when measured by a five station OSCE and provide an excellent complementary resource to address current deficits in MSK PE teaching.

Reforming the teaching of physical examination based on the Miller Pyramid for Assessing Clinical Competence

Based on the Miller Pyramid for assessing clinical competence, this article analyzed the existing problems in the practice of teaching physical examination and provided suggestions for possible reforms. Key words: Miller Pyramid principle; Physical examination; Education; reform

Bedside teaching of clinical reasoning and evidence-based physical examination

Context and setting Medical school physical examination (PE) education focuses on the acquisition of skills in three domains: psychomotor (motor skills); affective (interaction with examinees), and cognitive (interpretation). To reinforce learning in the cognitive domain, we currently offer an advanced physical diagnosis elective to senior medical students to teach the principles of evidence-based physical examination (EBPE). Why the idea was necessary Recent studies have emphasised a ‘synthetic’ domain: practising doctors must not only recognise findings and understand their evidence-based utility, but must also make optimal management decisions based on these findings. ‘Synthesis’ is rarely taught; rather, students are expected to become adept simply with experience. Consequently, as they make the transition to internship, students may be ill-prepared to apply EBPE in practice. What was done The existing elective includes an introduction to the principles of EBPE. We developed a 3-hour structured bedside rounding session to reinforce key EBPE skills, including: estimation of pre-test probability; recognition of PE findings; evidence-based estimation of post-test probability of the disease, and decision making based on this assessment. For example, in a patient with dyspnoea, elevated neck veins, S3 heart sound and abdominojugular reflux, students decide whether to prescribe diuretics or to order an echocardiogram. Each session is structured as follows: faculty staff preselect two to four patients to examine at the bedside; small groups of three or four students examine the patients and are given feedback by the faculty staff about their examination technique and findings; the students commit to a next step in management, and the faculty staff provide feedback on the students’ decision making. Students answered preand post-elective questionnaires that measured their confidence in their ability to perform EBPE, the perceived utility of PE, and the usefulness of elective activities. Clinical vignettes presenting practice choices were used to assess clinical reasoning. Evaluation of results and impact Three 2-week electives were offered between November 2009 and March 2010. Twenty-one students participated. On a Likert scale of 1–5 (1 = not at all confident, 5 = very confident), students showed increased confidence in: (i) their PE skills in general (mean ± standard deviation [SD] score: retrospective pre-elective 3.38 ± 0.50, post-elective 4.19 ± 0.40; p < 0.05); (ii) understanding the significance of findings (mean ± SD: retrospective pre-elective 2.86 ± 0.57, post-elective 4.23 ± 0.44; p < 0.05), and (iii) making management decisions based on findings (mean ± SD: retrospective pre-elective 2.90 ± 0.87, post-elective 4.57 ± 0.60; p < 0.05). Most students requested that more bedside rounds be included in the elective. Vignettes designed to assess clinical reasoning won high pre-elective scores that did not change appreciably in post-elective testing. Our pilot of structured bedside rounds to teach senior medical students to recognise findings, understand their evidence-based utility and use assessments to make optimal management decisions was well received and valued by students. Students reported increased confidence in making management decisions based on PE findings at the end of the elective. However, improvement in clinical reasoning could not be detected using our assessments, indicating that better calibrated instruments to measure the synthetic domain must be developed.

Clinical instructors' perception of a faculty development programme promoting postgraduate year-1 (PGY1) residents' ACGME six core competencies: a 2-year study

ObjectiveThe six core competencies designated by Accreditation Council for Graduate Medical Education (ACGME) are essential for establishing a patient centre holistic medical system. The authors developed a faculty programme to...

Objetos virtuais para apoio ao processo ensino-aprendizagem do exame físico em enfermagem

OBJETIVO: Descrever o processo de construção dos objetos virtuais de aprendizagem do exame físico em enfermagem. MÉTODOS: O estudo envolveu o desenvolvimento de um produto e a pesquisa contemplou quatro etapas: planejamento, elaboração do modelo teórico, desenvolvimento dos objetos virtuais e avaliação por 19 especialistas e 38 discentes. RESULTADOS: Ressalta-se a importância das etapas para a construção de objetos virtuais. Na avaliação global, o Ranking médio mostrou que das 31 variáveis avaliadas, 18 atingiram escores entre 4-5, 11 entre 3-3,9 e 2 com escores entre 2-2,9. CONCLUSÃO: A inovação pela consolidação do uso das tecnologias computacionais integradas ao ensino de graduação em Enfermagem deve apoiar o processo de ensino e aprendizagem do exame físico em enfermagem, otimizando as atividades desenvolvidas intra e extraclasse e maximizando os resultados de aprendizagem.

A Qualitative Study of the Meaning of Physical Examination Teaching for Patients

Physical examination teaching using actual patients is an important part of medical training. The patient experience undergoing this type of teaching is not well-understood. To understand the meaning of physical examination teaching for patients. Phenomenological qualitative study using semi-structured interviews. Patients who underwent a physical examination-based teaching session at an urban Veterans Affairs Medical Center. A purposive sampling strategy was used to include a diversity of patient teaching experiences. Multiple interviewers triangulated data collection. Interviews continued until new themes were no longer heard (total of 12 interviews). Interviews were recorded and transcribed verbatim. Coding was performed by two investigators and peer-checked. Themes were identified and meanings extracted from themes. Seven themes emerged from the data: positive impression of students; participation considered part of the program; expect students to do their job: hands-on learning; interaction with students is positive; some aspects of encounter unexpected; range of benefits to participation; improve convenience and interaction. Physical examination teaching had four possible meanings for patients: Tolerance, Helping, Social, and Learning. We found it possible for a patient to move from one meaning to another, based on the teaching session experience. Physical examination teaching can benefit patients. Patients have the potential to gain more value from the experience based on the group interaction.

Near-peer videos for physical examination instruction

element of medical education. Why the idea was necessary In addition to the best evidence, good doctors also use individual clinical expertise. We already know that many hours of practice are necessary to become an expert. The student who is well prepared for physical examination assessment will have seen, experienced and learned more medicine through practice on a high volume of cases. Furthermore, it has been shown that deliberate practice of a task is a far better method of acquiring expertise than simple unstructured practice. What was done With this in mind we conceived the Physical Examination Audit Tool (PEAT). This is a checklist of the stages of an ‘ideal’ physical examination, which is written up by each student using the best available evidence and used to audit performance. This has the manifold benefits of empowering students to learn, promoting a deeper (evidencebased) understanding of the physical examination and facilitating structured practice. Evaluation of results and impact We conducted a qualitative study of final-year medical students at Bristol University who adopted this method in their preparation for final examinations. Data were collected using interviews and questionnaires, and analysed using grounded theory. Full ethical approval was granted and each participant gave fully informed consent. The PEAT was introduced to a population of 16 students during a tutorial in week 1 of an 8-week attachment and an evidence-based clinical skills textbook was recommended as a starting point for reviewing evidence. Each student was allocated a junior doctor mentor to help with problems encountered while writing his or her own PEAT. Each student was encouraged to practise physical examination on as many patients as possible, each time using the PEAT to make note of procedures forgotten or performed incorrectly. Data analysis identified two core shared themes. Firstly, it was agreed by 75% of PEAT users that PEAT encouraged them to bring evidence-based enquiry into their examination technique. Secondly, all candidates who used PEAT made comments relating to a theme of ‘improved technique’: 50% of candidates commented that it helped to identify areas frequently missed in the examination and one candidate commented that it helped him become ‘more thorough, efficient and structured’. Of note, no respondents highlighted the same areas in which their practice changed, which implies that this approach is well tailored to individual student needs. In conclusion, this method empowers the student to scrutinise accepted checklists, promotes self-directed, structured practice and highlights areas of weakness through the self-audit of performance.

Quantification of bedside teaching by an academic hospitalist group

Medical educators have raised serious concerns about the decline in bedside teaching and the effect of this decline on trainee skills. We investigated the fraction of time hospitalist attending physicians spend at the bedside during teaching rounds and how often physical examination skills are demonstrated. In a prospective, observational study, the authors investigated the rounding behavior of members of Brigham and Women's Hospitalist Service. For 5 weeks from December 2007 to January 2008, interns and residents rotating on the hospitalist service reported in a daily e-mail (1) total time spent with their attending during attending rounds, (2) time spent inside patient rooms during attending rounds, and (3) whether or not a physical examination finding or technique was demonstrated by their hospitalist attending. A total of 61 observations were reported (66% response). Hospitalists spent an average of 101 minutes on teaching rounds and an average of 17 minutes inside patient rooms or 17% of their teaching time at the bedside. Bedside teaching occurred during 61% of teaching sessions and physical examination teaching occurred during 38% of teaching sessions. Rounds that included time spent at the bedside were longer on average than rounds that did not include time spent at the bedside (122 vs. 69 minutes, P < 0.001). Bedside teaching makes up approximately 17% of the time that hospitalists at this medical center spend on teaching rounds. Physical examination teaching has become infrequent. Research to clarify optimal strategies to improve bedside teaching and its value in patient care is needed.

The Current State of Musculoskeletal Clinical Skills Teaching for Preclerkship Medical Students

Musculoskeletal (MSK) complaints have high prevalence in primary care practice (12%-20% of visits), yet many trainees and physicians identify themselves as weak in MSK physical examination (PE) skills. As recruitment to MSK specialties lags behind retirement rates, there is a shortage of physicians able to effectively teach this subject. We investigated current practices of Canadian undergraduate medical programs regarding the nature, amount, and source of preclerkship MSK PE clinical skills teaching; and documented the frequency and extent that Patient Partners in Arthritis (PPIA) are used in this educational setting. A 2-page self-administered electronic questionnaire combining open- and close-ended questions was developed and piloted. It was distributed by e-mail to all Canadian undergraduate associate-deans and to 16/17 undergraduate MSK course organizers. Supervised practice in small groups and the PPIA are the most prevalent teaching methods. Objective structured clinical examinations are the most prevalent evaluation methods. The average number of hours devoted to teaching these skills is very small compared to the prevalence of MSK complaints in the population. Canadian schools' preclerkship MSK PE clinical skills teaching is heavily dependent on the contributions of non-MSK specialists. The weak link in the Canadian MSK PE educational cycle appears to be the amount of time available for students' deliberate practice with expert feedback. There is a need for methods to evaluate and further develop MSK PE teaching by non-MSK specialists. This and increased use of PPIA at the preclerkship level may provide students more time for practice with feedback.

Twelve tips for excellent physical examination teaching

Background: Physical examination (PEx) skills are declining among medical trainees, yet many institutions are not teaching these systematically and effectively. Many variables contribute to effective teaching: teachers’ confidence in their clinical skills, ability to demonstrate and assess these skills; availability of suitable patients; trainee attitude and fatigue; belief that institutions do not value clinical teachers. Finally, the relevance and significance of a systematic exam must be demonstrated or the teaching degenerates into a ‘show-and-tell’ exercise.Aims: This paper describes twelve practical teaching tips that can be used to promote high quality PEx teaching in 5 minutes or 45 minutes.Teaching tips: (1) Diagnostic hypotheses should guide reflective exam; (2) Teachers with the best clinical skills should be recruited; (3) A longitudinal and systematic curriculum can tailor teaching to multiple learner levels (4) Integration of simulation and bedside teaching can maximise learning; (5) Bedside detective work and games make learning fun; (6) The 6-step approach to teach procedures can be adopted to teach PEx; (7) Clinical teaching at the bedside should be increased; (8) Linking basic sciences to clinical findings will demonstrate relevance; (9) Since assessment drives learning, clinical skills should be systematically assessed; (10) Staff development can target improvement of teachers’ clinical skills for effective teaching; (11) Technology should be used to study utility of clinical signs; (12) Institutions should elevate the importance of clinical skills teaching and recognize and reward teachers.Conclusions: PEx is important in patient-physician interactions, a valuable contributor to accurate clinical diagnosis and can be taught effectively using practical tips. To reverse the trend of deficient clinical skills, precision of clinical findings should be studied and exam manoeuvres that do not contribute to diagnosis discarded; institutions should value clinical skills teaching, appoint and fund core faculty to teach and provide staff development to improve teaching skills.

Teaching Foundational Physical Examination Skills: Study Results Comparing Lay Teaching Associates and Physician Instructors

The purpose of this pilot study was to determine differences in the physical exam skills of first-year medical students learning physical exam exclusively from standardized physical examination teaching associates (SPETAs) or physician faculty. In all, 144 first-year medical students were randomized to receive SPETA or physician-led physical examination instruction. Students participated in an OSCE assessment immediately following the end of the curriculum block. SPETA-trained students performed equivalently to physician faculty trained students across all stations with a mean of 82.9% versus 81.2% (p = .226). Students taught by SPETAs performed significantly better on the abdominal OSCE with a mean score of 88.8%, while physician faculty taught students had a mean score of 85.4% (p = .03). Findings from this study suggest that SPETAs can effectively teach foundational physical examination skills to medical students at a similar and sometimes better performance level as physician faculty.

Physical examination teaching curriculum for senior medical students

(1 1⁄4 much less comfortable, 5 1⁄4 much more comfortable). Cronbach’s alpha reliability for the OSCE was 0AE84. No differences were noted in OSCE scores between participants and controls in pulmonary (P 1⁄4 0AE40, 2-tailed t-test) or cardiac examinations (P 1⁄4 0AE46). Despite faculty perceptions that the ED was an effective learning environment and student reports that the ED sessions improved their skills competency and increased their comfort in examining patients, these ED experiences did not result in demonstrable improvements in students’ OSCE scores. Although these results suggest that these early clinical experiences may be of limited educational value, further work is needed to strengthen the ED educational programme and to increase the OSCE’s sensitivity to the clinical skills learned in the ED setting.

Medical education fellowship: fostering early interest in education

Context and setting Since 1998 our institution has been steadily increasing student involvement in teaching and curriculum development. In 2004 a formal Medical Education Area of Concentration was created, a programme comparable to a ‘minor’ in college. Additionally, a fellowship in medical education was initiated to provide an opportunity for more extensive and focused exposure to medical education. Why the idea was necessary Currently, training of medical educators is often informal, limited and available only to those further along in their careers. This fellowship is an opportunity to gain experience and insight into medical education early in career development. Furthermore, as successful student involvement in medical education has demonstrated, medical education fellows can contribute productively to teaching, curriculum development and scholarly endeavours. The medical education fellowship, therefore, benefits the institution as well as the fellow. What was done The fellowship was designed to expose fellows to the full scope of medical education. Under the guidance of the Associate Dean for Curriculum, fellowship curricula were tailored to meet the needs of each fellow while including exposure to direct teaching, curriculum development, leadership, scholarship and education theory. Fellows were funded by a stipend from the Office of Medical Education. Evaluation of results and impact One fellow participated in 2003–04, and 3 in 2004–05. Two of 4 fellows completed the fellowship immediately following undergraduate medical training, a third before the fourth year of medical school, and the fourth after 1 year of residency. Teaching was the most common component shared by all fellows. Teaching occurred primarily in the small-group setting, although there were also opportunities for physical examination instruction and lecturing. Fellows' small-group teaching evaluations averaged 4.52 (scale 1 = poor, 5 = excellent) for overall teaching effectiveness compared to the average overall rating of 4.13 for all pre-clerkship small-group teachers at our institution. Two fellows received teaching awards and 1 fellow was nominated. Fellows also contributed to scholarly work with a current tally of 1 manuscript in preparation, 1 poster presentation at a national meeting, 2 poster presentations at regional meetings and 1 oral and 5 poster presentations at intramural meetings. All fellows served on pre-clerkship and clinical curriculum committees and participated in curriculum retreats. Two fellows joined the year-long Teaching Scholars Programme for faculty development. All 4 fellows concur that the experience increased their interest and skills in medical education and desire for a future career in academic medicine. For those fellows completing the fellowship before residency, the fellowship influenced residency selection − fellows sought out residencies supportive of their continuing interest in education. Based on its early success the fellowship is being formalised with specific guidelines, structure and expectations, although its individualised design will be maintained. It will continue to serve as a valuable opportunity for educational and career development between undergraduate and graduate medical education.