A videotaped evaluation methodology was used to assess second year medical students' physical examination skills. Students were assigned to groups of three where each student in the group served as the physician, the patient, and the camera person until all students had been videotaped performing an examination. Each group of three students reviewed the videotapes and evaluated their own as well as their peers' performance using criterion-based checklists. Faculty and staff members also reviewed the tapes and evaluated the examinations using the same evaluation checklists as the students. This videotaping evaluation methodology provides several benefits: (1) patients are not required, thus increasing flexibility in scheduling and evaluation opportunities;(2) technical staff can monitor and run the videotaping sessions; and (3) faculty can review the videotapes in their off hours rather than trying to obserue the examinations during a busy day. Additionally, the peer and self-assessments based upon checklists provides immediate feedback to the students regarding their performance.
Current undergraduate medical education is criticized for not preparing physicians to be independent thinkers. The rapid development of new imaging techniques and the problem of escalating medical costs call for efficient patient management. The development of algorithms in imaging work-up of patient problems is an excellent example of problem solving or medical decision making. The senior elective in radiology at our institution incorporates this type of problem-solving session. Small groups (15-25 students) with faculty guidance discuss 5-6 common patient problems to develop an investigative plan in imaging. Algorithms are thus developed by the group, but not presented for memorization. Small changes are then made in the case history so that the students are forced to make new hypotheses and generate a modified algorithm. Correlative costs are included. Flexibility and initiative in development of patient management algorithms are stressed.
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