Linda R Tewksbury, MD; Paik Steve, MDEdM; Richter A Regina, BA; Gillespie C Colleen, PhD; Kalet L Adina, MDMPH New York University School of Medicine, New York, NY
Objective: To explore the relationship between patient encounters during the pediatric clerkship and performance on an adolescent OSCE.
Design/Methods: Medical students on the pediatric clerkship were required to enter all patient encounters into a web-based log. Data included time of rotation, age and gender of patient, and level of encounter (observation (OB) vs direct performance (DP) of H&P). Students were randomly assigned to 8 OSCE stations at the end of 3rd year, one including an adolescent SP interview. SP evaluated communication (CS) and history gathering (HG) skills. Clinical reasoning (CR) skills were evaluated by a trained faculty based on student note.
Results: 133/162 (82%) of students completing the pediatric clerkship in 2005-6 were assigned to the adolescent OSCE. For the 118 consented students, mean (SD) number of total patient encounters was 67 (34). Students encountered a mean (SD) of 13 (5.5) adolescent patients (age 13-19yrs), and 8 (4.5) were at DP level. The number of adolescent encounters correlated with CR (r = .21, p<.05 ) but not HG or PE performance on the adolescent OSCE. A backward stepwise regression analysis including time of rotation, number and type (age, gender, level) of encounter demonstrated that the number of adolescent encounters at DP level was the only significant predictor of CR (r2= .241, p=.009).
Conclusions: The number of history and physical exams independently performed by medical students during a pediatric clerkship weakly correlates with clinical reasoning ability based on OSCE performance. The results suggest that quantity and quality of patient encounters influence development of clinical skills but further research is required to determine if any threshold exists.