There was a wide variation in how medical schools teach the physical exam to preclerkship students. Common pedagogical approaches included early initiation of physical exam instruction, use of technology, and methods that support clinical reasoning and competency-based medical education. Approaches used by a minority of schools included interprofessional education, ultrasound, and criterion-based standard setting methods for assessments. Opportunities abound for research into the optimal methods for teaching the physical exam.
Introduction: Resuscitation skills decay as early as 4 months after course acquisition. Gaps in research remain regarding ideal educational modalities, timing, and frequency of curricula required to optimize skills retention. Our objective was to evaluate the impact on retention of resuscitation skills 8 months after the Pediatric Advanced Life Support (PALS) course when reinforced by an adjunct simulation-based curriculum 4 months after PALS certification. We hypothesized there would be improved retention in the intervention group.Methods: This is a partial, double-blind, randomized controlled study.First-year pediatric residents were randomized to an intervention or control group. The intervention group participated in a simulation-based curriculum grounded in principles of deliberate practice and debriefing. The control group received no intervention. T-tests were used to compare mean percent scores (M) from simulation-based assessments and multiple-choice tests immediately following the PALS course and after 8 months.Results: Intervention group (n = 12) had overall improved retention of resuscitation skills at 8 months when compared with the control group (n = 12) (mean, 0.57 ± 0.05 vs 0.52 ± 0.06; P = 0.037). No significant difference existed between individual skills stations. The intervention group had greater retention of cognitive knowledge (mean, 0.78 ± 0.09 vs 0.68 ± 0.14; P = 0.049). Residents performed 61% of assessment items correctly immediately following the PALS course.Conclusions: Resuscitation skills acquisition from the PALS course and retention are suboptimal. These findings support the use of simulationbased curricula as course adjuncts to extend retention beyond 4 months.
The modified Delphi method resulted in a weighted scoring system that can be used to objectively assess team performance.
Objectives:We evaluated the reliability and predictive ability of an objective structured clinical examination (OSCE) in the assessment of medical students at the completion of a neurology clerkship. Methods:We analyzed data from 195 third-year medical students who took the OSCE. For each student, the OSCE consisted of 2 standardized patient encounters. The scores obtained from each encounter were compared. Faculty clinical evaluations of each student for 2 clinical inpatient rotations were also compared. Hierarchical regression analysis was applied to test the ability of the averaged OSCE scores to predict standardized written examination scores and composite clinical scores.Results: Students' OSCE scores from the 2 standardized patient encounters were significantly correlated with each other (r ϭ 0.347, p Ͻ 0.001), and the scores for all students were normally distributed. In contrast, students' faculty clinical evaluation scores from 2 different clinical inpatient rotations were uncorrelated, and scores were skewed toward the highest ratings. After accounting for clerkship order, better OSCE scores were predictive of better National Board of Medical Examiners standardized examination scores (R 2 ⌬ ϭ 0.131, p Ͻ 0.001) and of better faculty clinical scores (R 2 ⌬ ϭ 0.078, p Ͻ 0.001). There is a developing body of research on clinical neurology education. 1 One goal in neurology education is improved student assessment using valid objective methods demonstrating consistency and also providing well-distributed scores, avoiding the grade inflation prevalent with faculty evaluations. Semiobjective systems using nonstandardized patients to evaluate performance on neurology clerkships have been reported. These have shown, however, limited ability to predict subjective clinical scores in neurology. Conclusions:2 An alternative approach is use of an objective structured clinical examination (OSCE) in neurology.3-6 The OSCE involves a series of encounters objectively testing clinical competencies including history taking, physical examination, communication, and data interpretation. It can be both a formative and summative evaluation.7 Feasibility of use of an OSCE in the examination of medical students at the completion of a neurology clerkship has been reported, 3,4,6,8 -10 but assessment of its reliability as an evaluation tool in a neurology clerkship has not been described.We recently implemented an OSCE as a supplementary tool for the objective assessment of clinical skills of medical students completing the neurology clerkship. We assessed the parallel forms reliability of this OSCE by comparing student performance across 2 separate standardized patient (SP) experiences. We also tested the OSCE's ability to predict outcomes on other
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