Clinical skills in early postgraduate medical trainees: patterns of acquisition of confidence and experience among junior doctors in a university teaching hospital

Marel, Geoffrey M.; Lyon, Patricia M.; Field, Michael J.; Barnsley, Leslie; Hibbert, Emily; Parise, Athina

doi:10.1046/j.1365-2923.2000.00730.x

Cited by 45 publications

(40 citation statements)

References 3 publications

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“…So, here again we see a difference between objectively measured and self-assessed growth. From the literature we know that a direct relation between self-assessed and objectively measured clinical competence seems not to exist (Kegel-From, 1975;Marel et al, 2000;Speechly et al, 1994). Our study shows that also the growth of both of them during training seems not to be related to each other.…”

Section: Discussionmentioning

confidence: 99%

“…Even repeated personal feedback based on objective knowledge and skills scores did not improve the accuracy (Jansen et al, 1998). From these findings it may be concluded that self-assessment of clinical competence apparently reveals to what extent someone considers her/ himself competent (self-perceived competence) (Kegel-From, 1975;Marel et al, 2000;Speechly et al, 1994) rather than actual clinical competence (Calhoun et al, 1990;DiMatteo and DiNicola, 1981;Jansen et al, 1998;Johnson and Cujec, 1998;Purdy, 1997).…”

Section: Introductionmentioning

confidence: 98%

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Growth of Self-Perceived Clinical Competence in Postgraduate Training for General Practice and its Relation to Potentially Influencing Factors

Kramer

Zuithoff²,

Jansen³

et al. 2006

Adv Health Sci Educ Theory Pract

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Objective: To examine the increase in self-perceived clinical competence during a three-year postgraduate training in general practice and to explore the relation between the growth of self-perceived competence and several background variables. Design: Cohort, 1995-1998. Setting: Three-year Postgraduate Training for General practice in the Netherlands Participants: All Dutch trainees who followed postgraduate training from September 1995 to September 1998 (N=191). Intervention: We asked the trainees at the start and at the end of their postgraduate training to complete a questionnaire, which assessed their self-perceived knowledge, clinical skills and consultations skills. We collected information about potentially influencing background variables. Amongst these were variables such as: age, gender, prior medical experience, the effort someone has spent upon her/his education, insight in weak and strong areas of clinical competence and knowledge and skills levels. Main outcome measure: Self-perceived competence. Results: A total of 127 trainees completed both questionnaires (190 at the first administration and 128 at the second one). We found statistically significant growth of self-perceived clinical competence. Self-perceived consultation skills increased more than self-perceived knowledge and clinical skills. The afore mentioned background variables did not relate in any way with the growth of self-perceived clinical competence. Conclusion: This study shows that a 3-year postgraduate training in general practice enhances self-perceived clinical competence. However, we still do not know how to explain this improvement. Further study into the theoretical concept of self-assessment in medical education and into the factors contributing to the feeling of being competent, is required.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Growth of Self-Perceived Clinical Competence in Postgraduate Training for General Practice and its Relation to Potentially Influencing Factors

Kramer

Zuithoff²,

Jansen³

et al. 2006

Adv Health Sci Educ Theory Pract

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“…The relationship between inadequate educational preparation in medical and dental schools and the difficulties experienced by this patient population in gaining access to community based heath services was emphasized in an additional report (Fenton et al, 2003). Essentially, clinical experience with a given patient population increases the confidence of clinicians to treat that population (Marel et al, 2000;Ferrini and Klein, 2006).…”

Section: Introductionmentioning

confidence: 99%

Preparing Health Professionals to Provide Care to Individuals with Disabilities

Holder

Hood

2009

Int J Oral Sci

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Methodology An e-mailed questionnaire with follow-up was sent to 198 deans of dental/medical schools, 1,628 directors of residency programs in nine medical/dental residency programs, 427 medical students in 12 medical schools, and 368 health related organizations, facilities and programs.Results More than half (58%) of the responding deans of medical schools and 50% of the deans of dental schools reported that a curriculum for patients with disabilities was not a high priority at their school. A majority (61%) of deans of medical schools, and 47% of the deans of dental schools, reported that their graduates were competent to treat patients with disabilities. However, majorities of dental/ medical school seniors and graduates expressed inadequate competency in the care of these patients. A majority of the directors of medical/dental residencies indicated a need for additional training for their residents. ConclusionThere is need for increased didactic and clinical preparation of dental/medical school graduates in the care of individuals with special health needs. The interest expressed by health profession educators in an effort to develop appropriate curriculum modules provides an opportunity to prepare new graduates for the care of an increasing population of individuals with disabilities.

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“…The fact that PGY-2s in this study were more confident on certain exam skills than incoming interns but performed at the same level on the CE might reflect a lack of emphasis on physical diagnosis teaching and practice prior to the start of the ACE curriculum. This gap between confidence and competence is an important one to address for trainees, as it directly impacts the safety and quality of patient care [37,38].…”

Section: Discussionmentioning

confidence: 99%

A novel bedside cardiopulmonary physical diagnosis curriculum for internal medicine postgraduate training

et al. 2017

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Background: Physicians spend less time at the bedside in the modern hospital setting which has contributed to a decline in physical diagnosis, and in particular, cardiopulmonary examination skills. This trend may be a source of diagnostic error and threatens to erode the patient-physician relationship. We created a new bedside cardiopulmonary physical diagnosis curriculum and assessed its effects on post-graduate year-1 (PGY-1; interns) attitudes, confidence and skill. Methods: One hundred five internal medicine interns in a large U.S. internal medicine residency program participated in the Advancing Bedside Cardiopulmonary Examination Skills (ACE) curriculum while rotating on a general medicine inpatient service between 2015 and 2017. Teaching sessions included exam demonstrations using healthy volunteers and real patients, imaging didactics, computer learning/high-fidelity simulation, and bedside teaching with experienced clinicians. Primary outcomes were attitudes, confidence and skill in the cardiopulmonary physical exam as determined by a self-assessment survey, and a validated online cardiovascular examination (CE). Results: Interns who participated in ACE (ACE interns) by mid-year more strongly agreed they had received adequate training in the cardiopulmonary exam compared with non-ACE interns. ACE interns were more confident than non-ACE interns in performing a cardiac exam, assessing the jugular venous pressure, distinguishing 'a' from 'v' waves, and classifying systolic murmurs as crescendo-decrescendo or holosystolic. Only ACE interns had a significant improvement in score on the mid-year CE. Conclusions: A comprehensive bedside cardiopulmonary physical diagnosis curriculum improved trainee attitudes, confidence and skill in the cardiopulmonary examination. These results provide an opportunity to re-examine the way physical examination is taught and assessed in residency training programs.

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Clinical skills in early postgraduate medical trainees: patterns of acquisition of confidence and experience among junior doctors in a university teaching hospital

Abstract: Early postgraduate medical trainees in a Sydney teaching hospital acquire high levels of confidence and experience in most skill areas after two years of training. The first postgraduate year is particularly significant for the development of clinical skills.

Cited by 45 publications

References 3 publications

Growth of Self-Perceived Clinical Competence in Postgraduate Training for General Practice and its Relation to Potentially Influencing Factors

Growth of Self-Perceived Clinical Competence in Postgraduate Training for General Practice and its Relation to Potentially Influencing Factors

Preparing Health Professionals to Provide Care to Individuals with Disabilities

A novel bedside cardiopulmonary physical diagnosis curriculum for internal medicine postgraduate training

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