Thoracentesis is an invasive procedure known to result in complications. Procedure skills should be taught and evaluated more effectively to improve health care quality. Validated checklists are central to teaching and assessing procedural skills. The results of the first step of the validation of a thoracentesis checklist are described. A comprehensive literature review of articles published on thoracentesis did not yield a validated checklist. A modified Delphi technique, involving a panel of 8 interdisciplinary, interinstitutional experts, was used to develop a thoracentesis checklist. The internal consistency coefficient using Cronbach's α was .94. Developing the 23-item thoracentesis checklist for teaching and assessing thoracentesis is the first step in the validation process. For this checklist to become further validated, it should be implemented and studied in the simulation and clinical environments.
The pattern of correlations supports each test's construct validity. The low correlations suggest that the tests are not redundant, and do not support using the scores on the school's assessment to predict performance on Step 2 CS. Future studies of these relationships need to address the time between the two assessments and the effect of intervening remedial programs.
Background and Objectives: New standards announced in 2017 could increase the failure rate for Step 2 Clinical Skills (CS). The purpose of this study was to identify student performance metrics associated with risk of failing.
Methods: Data for 1,041 graduates of one medical school from 2014 through 2017 were analyzed, including 30 (2.9%) failures. Metrics included Medical College Admission Test, United States Medical Licensing Examination Step 1, and clerkship National Board of Medical Examiners (NBME) Subject Examination scores; faculty ratings in six clerkships; and scores on an objective structured clinical examination (OSCE). Bivariate statistics and regression were used to estimate risk of failing.
Results: Those failing had lower Step 1 scores, NBME scores, faculty ratings, and OSCE scores (P<.02). Students with four or more low ratings were more likely to fail compared to those with fewer low ratings (relative risk [RR], 12.76, P<.0001). Logistic regression revealed other risks: low surgery NBME scores (RR 3.75, P=.02), low pediatrics NBME scores (RR 3.67, P=.02), low ratings in internal medicine (RR 3.42, P=.004), and low OSCE Communication/Interpersonal Skills (RR 2.55, P=.02).
Conclusions: Certain medical student performance metrics are associated with risk of failing Step 2 CS. It is important to clarify these and advise students accordingly.
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