Voluntary attendance of small-group brainstorming tutoring courses intensify new clerk’s “excellence in clinical care”: a pilot study

Abstract

BackgroundClerkship provides a unique way of transferring the knowledge and skills gathered during medical school’s curriculum into real-ward clinical care environment. The annual program evaluation has indicated that the training of clerks in diagnostic and clinical reasoning skills needed to be enhanced. Recently, “clinical excellence” program have been promoted in our institution to augment the excellence in clinical care of new clerks. Current study aims to evaluate whether this pilot program improve the “clinical excellence” of new clerks.MethodsIn a pilot study, groups of new clerks in years 2013 and 2014 voluntarily attended either a small-group brainstorming course or a didactic classroom tutoring courses as part of their 3-month internal medicine clinical rotation block. A third group of new clerks did not join either of the above courses and this group served as the control group. Pre-block/post-block self-assessment and post-block 5-station mini-Objective Subjective Clinical Examinations (OSCEs) were used to evaluate the effectiveness of these two additional courses that trained diagnostic and clinical reasoning skills.ResultsOvertime, the percentages of new clerks that attended voluntarily either the small-group brainstorming or classroom tutoring courses were increased. Higher post-block self-assessed diagnostic and clinical reasoning skill scores were found among individuals who attended the small-group brainstorming courses compared to either the didactic group or the control group. In a corresponding manner, the small-group brainstorming group obtained higher summary OSCEdiag and OSCEreason scores than either the didactic group or control group. For all basic images/laboratory OSCE stations, the individual diagnostic skill (OSCEdiag) scores of the small-group brainstorming group were higher than those of the didactic group. By way of contrast, only the clinical reasoning skill (OSCEreason) scores of the basic electrocardiogram and complete blood count + biochemistry OSCE station of thesmall-group brainstorming group were higher than those of the didactic group. Among the small-group brainstorming group, clerks with higher cumulative learning hours (>30-h) had significant higher OSCEdiag and OSCEreason scores (>400) than those with less cumulative learning hours.ConclusionOur pilot study provides a successful example of the use of a small-group tutoring courses for augmenting the diagnostic and clinical reasoning skills of new clerks. The positive results obtained during the initial 2-year long pilot “clinical excellence” program have encouraged the formal implementation of this course as part of the clerkship curriculum.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0843-6) contains supplementary material, which is available to authorized users.

Do consecutive Patient Management Problem (PMP) and Modified Essay Question (MEQ) Examinations Improve Clinical Reasoning in Students?

“…In this regard, a previous study provided a successful example of a small-group brainstorming course for enhancing the diagnostic and clinical reasoning skills of new medical clerks. The positive results obtained during the "clinical excellence program" encouraged the formal implementation of this course as part of the clerkship curriculum (15). Therefore, the small group teaching-learning approach is one of the effective approaches, which can improve clinical reasoning skills.…”

Black Ice: Five ways to get a grip on grouped self-assessments of competence for program evaluation

“…[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Six studies measured competency or ability, 10,13,[22][23][24][25] two studies measured readiness, 9,16 and five studies e92 lacked sufficient detail to determine what they used. [26][27][28][29][30] Measuring one's willingness to perform a task or one's confidence helps promote reflection of performance 3 but is not the most effective method of evaluating learning or performance. Additionally, pre-test GS-a coupled with post-test GSa are inadequate measurements of program results.…”

“…According to our analysis, five studies had not used any pre-intervention assessments at all. 5,10,18,22,28 Eighteen studies administered pre-post self-assessments, 4,[6][7][8][9][12][13][14][15][16][17]19,21,23,25,27,29,30 whereas only three studies employed post-intervention retrospective pre-test selfassessments. 11,24,26 One study had employed both pre-intervention pre-test and post-intervention retrospective pre-test self-assessments.…”

“…[4][5][6][7][8][9][10][12][13][14][15][16][17][18][21][22][23][24][25]28,29 Yet, five studies either lacked sufficient details to determine what they used or used topic areas and broad domains instead of learning objectives. 11,20,26,27,30 When selfassessments refer to ambiguous learning objectives, respondents may not be able to accurately interpret what they are expected to assess. If ambiguous learning objectives or broad topic areas are used, respondents' interpretations of what they were supposed to self-assess may differ from the interpretations of other respondents, the educators, and researchers.…”

“… 4 – 21 Six studies measured competency or ability, 10 , 13 , 22 – 25 two studies measured readiness, 9 , 16 and five studies lacked sufficient detail to determine what they used. 26 – 30 Measuring one’s willingness to perform a task or one’s confidence helps promote reflection of performance 3 but is not the most effective method of evaluating learning or performance.…”