Introduction of structured physical examination skills to second year undergraduate medical students (original) (raw)
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F1000 - Post-publication peer review of the biomedical literature
Effective learning of physical examination skills (PES) requires Introduction: suitable teaching and learning techniques and assessment methods. The Tribhuvan University (Nepal) curriculum recommends involving the departments of Medicine and Surgery in PES training (PEST) for second year students as a part of early clinical exposure. The project was developed to make teaching/learning of PES structured, involving eight clinical sciences departments and using appropriate methods for teaching and assessment in KIST Medical College, Nepal. Irby's three stages of clinical teaching model (Preparation, Teaching, Methods: Reflection), was applied for teaching. Skill acquisition was based on Millers' learning pyramid at "show how level" and Dreyfus' competency model at "competent level". Teaching/learning was conducted in small groups. A tutorial, demonstration and practice (TDS) model was developed for teaching/learning techniques based on a simple five-step method for teaching clinical skills. Assessment of effectiveness of training was done at "reaction level" as per Kirkpatrick's model based on students' feedback, "shows how level" as per Miller's pyramid of learning by OSCE and "competent level" as per Dreyfus' model using retro-pre questionnaire. The analysis of retro-pre questionnaire based on the Dreyfus model Results: found the average skill score (max score 184), before the introduction of the project module as 15.9 (median = 13.5) and after as 116.5 (median = 116). A paired t-test showed the difference to be statistically significant (100.5±23 and 95% CI 95.45-105.59). The average overall feedback score for the students on PES training based on seven items on a five point Likert scale was found to be 4.30. The mean total objective structured clinical examination (OSCE) score was 3.77 (SD+/-0.33) out of 5; 80% of students scored more than 70%. Students learned most of the skills with the implementation of the Conclusion: structured PES module and did well in the OSCE. Students and faculty were satisfied with the training and assessment. Referees v1
GMS Zeitschrift für medizinische Ausbildung, 2013
Regular student evaluations at the Technical University Munich indicate the necessity for improvement of the clinical examination course. The aim of this study was to examine if targeted measures to restructure and improve a clinical examination course session lead to a higher level of student satisfaction as well as better self-assessment of the acquired techniques of clinical examination. At three medical departments of the Technical University Munich during the 2010 summer semester, the quantitative results of 49 student evaluations (ratings 1-6, German scholastic grading system) of the clinical examination course were compared for a course before and a course after structured measures for improvement. These measures included structured teaching instructions, handouts and additional material from the Internet. 47 evaluations were completed before and 34 evaluations after the measures for improvement. The measures named above led to a significant improvement of the evaluative rati...
2015
Purpose: The effectiveness of physical examination skills (PES) training is very rarely assessed using the "post-then-pre" approach. In this study, a retro-pre-questionnaire was used to study the effect of structured physical examination skills training (SPEST) imparted to second-year undergraduate medical students. Methods: KIST Medical College (KISTMC) affiliated to Tribhuvan University Nepal admitted its first batch of MBBS students in November 2008. The university curriculum recommends the involvement of Medicine and Surgery Departments in PES training, but the methods for teaching and assessment are not well defined. KISTMC has made training more structured and involved the Medicine, Surgery, Gynaecology and Obstetrics, Orthopaedics, ENT, Ophthalmology, Paediatrics, and Family Medicine Departments. SPEST includes the teaching/learning of basic PES for 210 minutes once a week for 28 weeks. Self-assessment is done by using a retro-pre-questionnaire at the end of the last session of training, and these data are analysed using SPSS. Results: Out of 100 students, 98 participated in the objective structured clinical examination (OSCE); 82 completed the retro-pre-questionnaire. Forty-six skills representing various systems were selected for inclusion in the retro-pre-questionnaire from among the many skills taught in different departments. The average perceived skills score (maximum score, 46× 4= 184) before training was 15.9 and increased to 116.5 after training. The increase was statistically significant upon the application of a paired t-test. Conclusion: The students perceived that their level of skills improved after the training. The retropre-instrument seems to be useful for assessing the learners' self-reported changes in PES after training if a large number of skills need to be assessed. However, it should be noted that although a retro-pre-questionnaire may reveal valuable information, it is not a substitute for an objective measure or gold standard.
Assessment of structured physical examination skills training using a retro-pre-questionnaire
Journal of educational evaluation for health professions, 2013
The effectiveness of physical examination skills (PES) training is very rarely assessed using the "post-then-pre" approach. In this study, a retro-pre-questionnaire was used to study the effect of structured physical examination skills training (SPEST) imparted to second-year undergraduate medical students. KIST Medical College (KISTMC) affiliated to Tribhuvan University Nepal admitted its first batch of MBBS students in November 2008. The university curriculum recommends the involvement of Medicine and Surgery Departments in PES training, but the methods for teaching and assessment are not well defined. KISTMC has made training more structured and involved the Medicine, Surgery, Gynaecology and Obstetrics, Orthopaedics, ENT, Ophthalmology, Paediatrics, and Family Medicine Departments. SPEST includes the teaching/learning of basic PES for 210 minutes once a week for 28 weeks. Self-assessment is done by using a retro-pre-questionnaire at the end of the last session of train...
International Journal of Research Studies in Psychology, 2015
The aim of this study was to evaluate students' perception on effect of basic clinical skills (BCS) training in preclinical phase to national Objective Structured Clinical Examination (OSCE). Cross sectional study was conducted at Faculty of Medicine and Health Sciences (FMHS) during January and December 2013. After students finished national OSCE, they were asked to fill up questionnaire that comprised their perception on effect of BCS training in preclinical phase whether helpful to pass national OSCE. There were nine items questionnaire with Likert Scale of 1-5 (strongly disagree to strongly agree) and open question for comments. There were 50 students of total 53 students involved (response rate was 94.3%). Generally students' perception on effect of BCS training to national OSCE was fair (3.53 ± 0.58). Students revealed that preclinical phase curriculum didn't effect to their succeed to pass national OSCE, whilst physical examination training gained the highest score (3.38 ± 0.87 and 3.66 ± 0.74, respectively). Overall students' perception on effect of BCS training to national OSCE was fair. In the future, we have to revise our preclinical phase curriculum that integrate with BCS training curriculum and enhance students' clinical reasoning process to improve students' performance in national OSCE.
National OSCE result as parameter outcome of basic clinical skills training during preclinical phase
International Journal of Research Studies in Psychology, 2015
Since 2005 we have been teaching basic clinical skills (BCS) such as physical examination, and other procedural skills among medical students. Objective Structured Clinical Examination (OSCE) is a tool to assess those skills. On 2013 OSCE was implemented as national examination for all of Indonesian graduated medical students. National OSCE examined eight areas of competency. This study described national OSCE results to evaluate students in each area of competency and give suggestion to curriculum team to make appropriate improvement. Comparison were accomplished in each of the competency within OSCE. Results show that fifty three students enrolled in national OSCE 2013. Candidates' skills to do history taking was the best in all OSCE period, followed by patient's education and professionalism (mean over 77%). While, candidates seem less competent in diagnose and giving pharmacotherapy and non-pharmacotherapy (mean less than 60%). Physical examination and clinical procedures were quite good (mean around 60%). During preclinical phase students repeat history taking in every block. This repetition has great effect in skills mastery. While, students need more exercise to diagnose clinical case and giving treatment. This study revealed good competency in process skills (history taking, patient education and professionalism) while content skills (diagnosis and giving treatment) still need improvement. National OSCE result gave sufficient data for some improvement in learning process during preclinical and clinical phase.
Background One of the main goals of action research is to improve the quality of education at both individual and organizational levels. Management enables organizations to improve their performance in areas, which have the greatest impact on students’ learning and empowerment, without compromising the quality of education. Objectives In this study, we aimed to improve the quality of basic clinical skills training for nursing students in an action research, using the available resources. Methods In this action research, a sequential mixed method was applied. The participants in the qualitative phase included experts in the field of education, students, and stakeholders responsible for training at the nursing skills, midwifery, and medical-surgical nursing units of Razi Faculty of Nursing and Midwifery in Kerman, Iran. Assessment of facilities and resources in the quantitative phase was also carried out using a data collection form, a student survey form, and a checklist of basic clinical skills. The stages of action research included action planning for problem-solving, implementation, evaluation, and reflection. The students’ problems with the basic clinical skills and their possible causes were also identified. The most effective and practical solutions for quality improvement included improvement of the educational environment of skill laboratories, followed by the enhancement of skills assessment process using an objective structured clinical examination (OSCE). Results The conventional method failed in the assessment of students’ competence and lacked adequate objectivity and reliability. A significant difference was observed in the mean scores of basic clinical skills (e.g., injection, measurement of vital signs, and dressing) between the conventional method and OSCE (P < 0.05). From the viewpoint of students, OSCE is more reliable and accurate than the conventional method and uses more suitable educational materials and facilities. Conclusions Based on the findings, by improving the educational environment of clinical skills laboratories and implementation of OSCE, nursing students can translate their knowledge of basic clinical skills into practice. We can also improve the quality of health services and clinical care for patients and reduce the incidence of practical errors made by nursing students.
Introduction to Clinical Skills Assessment
Clinical skills assessment has a very important role in Health Professions Education. However, the basic requirements of its reliability and validity have not been achieved or taken much care of. A mini Clinical Evaluation Exercise (mini-CEX) is approximately a twenty minute encounter, during which a trainee performs focused history taking and physical examination of a patient in a real setting while the faculty assessor observes. After a discussion on the diagnosis and management plan for the patient, the faculty assesses the trainee using the mini-CEX evaluation form and provides feedback. Based on the literature review mini-CEX is found to be a valid and reliable assessment strategy for clinical competence. It has shown to be content valid and differentiates well between different performance levels for both postgraduate and undergraduate trainees. The results are fairly reliable on four or more encounters with the standard error of measurement being very small. The mini-CEX scores have shown to be criterion valid and have sufficient desired educational impact on trainees. Overall, mini-CEX is found to be a fairly valid and feasible assessment strategy for clinical skills justifying its use for both undergraduate and post-graduate education.
Medical …, 2009
CONTEXT Diagnostic accuracy is maximised by having clinical signs and diagnostic hypotheses in mind during the physical examination (PE). This diagnostic reasoning approach contrasts with the rote, hypothesis-free screening PE learned by many medical students. A hypothesis-driven PE (HDPE) learning and assessment procedure was developed to provide targeted practice and assessment in anticipating, eliciting and interpreting critical aspects of the PE in the context of diagnostic challenges.